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General NPI Number Information
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NPI Number | 1396534269
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Entity Type | Organization
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Legal Business Name | PRM GYNECOLOGY OF ILLINOIS SC
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 625 N MICHIGAN AVE STE 1810
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City | CHICAGO
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State | IL
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Zip | 60611-4592
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Country | US
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Telephone | 872-310-3920
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Fax |
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Provider Business Mailing Address
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Address Line | 2090 PALM BEACH LAKES BLVD STE 700
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6508
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Country | US
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Telephone | 561-422-4206
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLE
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Name | JANE MARIE LAGNESE
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Credential |
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Telephone | 561-422-4206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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