=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114392354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL ABOUT WOMENS HEALTH OBGYN & MIDWIFERY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2015
-----------------------------------------------------
Last Update Date | 12/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1890 SILVER CROSS BLVD STE 330
-----------------------------------------------------
City | NEW LENOX
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60451-9528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-717-6082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1890 SILVER CROSS BLVD STE 330
-----------------------------------------------------
City | NEW LENOX
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60451-9528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | HUSAM MARSHEH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 815-690-3131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 036110113
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------