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General NPI Number Information
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NPI Number | 1477741320
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Entity Type | Organization
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Legal Business Name | WOMENS CENTER OF NORTHERN ILLINOIS
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 303 ANDREWS DR 200
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City | BELVIDERE
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State | IL
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Zip | 61008-3918
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Country | US
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Telephone | 815-323-1133
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Fax |
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Provider Business Mailing Address
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Address Line | 6532 SPRING BROOK RD APT 203
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City | ROCKFORD
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State | IL
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Zip | 61114-8135
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Country | US
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Telephone | 815-323-1133
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JYOTHI GONDI
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Credential | M.D.
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Telephone | 815-323-1133
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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 |
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License Number State |
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