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General NPI Number Information
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NPI Number | 1063337426
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Entity Type | Organization
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Legal Business Name | IVY CHICAGO SC LLC
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 333 S DESPLAINES ST STE 101
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City | CHICAGO
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State | IL
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Zip | 60661-5514
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Country | US
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Telephone | 858-925-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 N BROADWAY # 36686
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City | LOS ANGELES
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State | CA
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Zip | 90012-1408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | KEVIN CIRILLO
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Credential |
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Telephone | 860-235-1246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0006X
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Taxonomy Name | Ambulatory Fertility Facility
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License Number |
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License Number State |
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