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General NPI Number Information
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NPI Number | 1063555456
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Entity Type | Organization
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Legal Business Name | ORCHID SUITE MEDICAL GROUP
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 8012 S CRANDON AVE STE 100
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City | CHICAGO
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State | IL
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Zip | 60617-1124
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Country | US
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Telephone | 773-356-5415
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Fax | 773-768-6141
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Provider Business Mailing Address
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Address Line | 400 E RANDOLPH ST SUITE 3730
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City | CHICAGO
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State | IL
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Zip | 60601-7329
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Country | US
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Telephone | 312-565-2267
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Fax | 312-861-9415
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNEST ANDERSON HAYES
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Credential | M.D.
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Telephone | 312-565-2267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 03643976
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License Number State | IL
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