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General NPI Number Information
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NPI Number | 1376732784
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Entity Type | Organization
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Legal Business Name | OBSTETRICS & GYNECOLOGY PC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR SUITE 830
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-440-1600
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Fax | 312-440-3508
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR SUITE 830
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-440-1600
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Fax | 312-440-3508
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MAUREEN PENDL
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Credential |
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Telephone | 312-440-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 060003474
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License Number State | IL
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