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General NPI Number Information
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NPI Number | 1174753735
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Entity Type | Organization
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Legal Business Name | LITTLE VILLAGE WOMENS HEALTH LLC
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 4230 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4316
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Country | US
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Telephone | 773-277-2227
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Fax | 773-522-5613
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Provider Business Mailing Address
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Address Line | 4230 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4316
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Country | US
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Telephone | 773-277-2227
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Fax | 773-522-5613
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SONYA LETRECE THOMAS
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Credential | MD
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Telephone | 773-277-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 036093278
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036093278
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License Number State | IL
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