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General NPI Number Information
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NPI Number | 1861857013
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Entity Type | Organization
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Legal Business Name | CENTERS FOR REPRODUCTIVE MEDICINE AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 6 BRONZE POINTE S
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City | SWANSEA
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State | IL
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Zip | 62226-8307
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Country | US
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Telephone | 866-577-7926
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Fax | 618-206-5017
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Provider Business Mailing Address
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Address Line | 6 BRONZE POINTE S
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City | SWANSEA
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State | IL
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Zip | 62226-8307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | AMBER COOPER
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Credential | MD
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Telephone | 314-791-6290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 036139075
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License Number State | IL
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