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General NPI Number Information
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NPI Number | 1104633866
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER FOR HUMAN REPRODUCTION, LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR STE 100
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City | CHICAGO
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State | IL
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Zip | 60611-4447
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Country | US
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Telephone | 312-288-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR STE 117
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City | CHICAGO
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State | IL
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Zip | 60611-4448
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Country | US
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Telephone | 312-288-6420
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | BETH ZONERAICH
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Credential |
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Telephone | 602-834-7227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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