MEDICARE: CONSULTANTS IN GYNECOLOGY, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0201X	Gynecologic Oncology Physician	036056308	IL
2	207VG0400X	Gynecology Physician	036080243	IL

General Provider Information

NPI Number	:	1194709931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSULTANTS IN GYNECOLOGY, S.C.

Provider Business Mailing Address
First Line	:	5747 DEMPSTER ST
Second Line	:	SUITE 100
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3056
Country	:	US
Telephone Number	:	847-663-1030
Fax Number	:	847-663-1039

Provider Business Practice Location Address
First Line	:	5747 DEMPSTER ST
Second Line	:	SUITE 100
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3056
Country	:	US
Telephone Number	:	847-663-1030
Fax Number	:	847-663-1039

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LAURA M KNAUS
Credential	:
Telephone Number	:	847-663-1054

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	06/25/2010

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