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General NPI Number Information
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NPI Number | 1114341567
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Entity Type | Organization
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Legal Business Name | CHICAGO CENTER FOR WOMENS HEALTH SC
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 6433 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-5148
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Country | US
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Telephone | 773-414-5670
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Fax | 773-585-7590
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Provider Business Mailing Address
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Address Line | 6433 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-5148
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Country | US
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Telephone | 773-414-5670
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Fax | 773-585-7590
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENISE MOLINA FURLONG
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Credential | MD
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Telephone | 773-414-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036110737
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License Number State | IL
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