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General NPI Number Information
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NPI Number | 1780739698
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Entity Type | Organization
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Legal Business Name | SUBURBAN WOMENS HEALTH SPECIALISTS LTD
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 2350 ROYAL BLVD SUITE 600
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City | ELGIN
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State | IL
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Zip | 60123-4719
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Country | US
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Telephone | 847-931-4747
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Fax | 847-931-9602
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Provider Business Mailing Address
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Address Line | 2350 ROYAL BLVD SUITE 600
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City | ELGIN
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State | IL
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Zip | 60123-4719
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Country | US
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Telephone | 847-931-4747
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Fax | 847-931-9602
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MARILYN GRAY
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Credential |
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Telephone | 847-931-4747
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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 | 042007882
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License Number State | IL
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