Healthcare Provider Details

I. General information

NPI: 1164566345
Provider Name (Legal Business Name): COMPREHENSIVE WOMENS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 E LAKE COOK RD
WHEELING IL
60090-2502
US

IV. Provider business mailing address

1083 E LAKE COOK RD
WHEELING IL
60090-2502
US

V. Phone/Fax

Practice location:
  • Phone: 847-808-7070
  • Fax: 847-808-7474
Mailing address:
  • Phone: 847-808-7070
  • Fax: 847-808-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number042617403
License Number StateIL

VIII. Authorized Official

Name: MARY C CHLIPALA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 847-808-7070