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General NPI Number Information
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NPI Number | 1881960961
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Entity Type | Organization
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Legal Business Name | NANCY R G CHURCH MD LLC
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 10725 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-3135
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Country | US
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Telephone | 773-233-6500
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Fax | 773-233-2369
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Provider Business Mailing Address
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Address Line | 10725 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-3135
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Country | US
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Telephone | 773-233-6500
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Fax | 773-233-2369
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Authorized Official
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Title or Position | OWNER
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Name | NANCY R CHURCH
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Credential | M D
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Telephone | 773-233-6500
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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 | 036085259
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License Number State | IL
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