=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235784760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GYNECOLOGIC SURGERY & MENOPAUSE SOLUTIONS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2019
-----------------------------------------------------
Last Update Date | 08/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1890 SILVER CROSS BLVD STE 445
-----------------------------------------------------
City | NEW LENOX
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60451-9622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-242-0625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1131 W JEFFERSON ST # 365
-----------------------------------------------------
City | SHOREWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60404-0701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | FRANCISCO J GARCINI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-242-0625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------