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General NPI Number Information
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NPI Number | 1679844039
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Entity Type | Organization
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Legal Business Name | ADVANCED GYNECOLOGY, S.C.
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Dates
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Enumeration Date | 01/17/2012
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 250 W KENSINGTON RD STE 1B
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City | MT PROSPECT
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State | IL
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Zip | 60056-1292
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Country | US
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Telephone | 847-568-1488
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Fax | 847-749-2695
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Provider Business Mailing Address
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Address Line | 250 W KENSINGTON RD STE 1B
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City | MT PROSPECT
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State | IL
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Zip | 60056-1292
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Country | US
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Telephone | 847-568-1488
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Fax | 847-749-2695
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Authorized Official
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Title or Position | OWNER AND PHYSICIAN
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Name | DR. SOGOL JAHEDI JIMENEZ
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Credential | MD
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Telephone | 847-568-1488
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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 | 042-619903
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License Number State | IL
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