MEDICARE: THE WOMEN INSTITUTE SC

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	207VG0400X	Gynecology Physician	036118733	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036118733	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1508183583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WOMEN INSTITUTE SC

Provider Business Mailing Address
First Line	:	1629 S PRAIRIE AVE
Second Line	:	# 1508
City	:	CHICAGO
State	:	IL
Zip	:	60616-4403
Country	:	US
Telephone Number	:	773-382-1224
Fax Number	:	773-362-1085

Provider Business Practice Location Address
First Line	:	4101 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2813
Country	:	US
Telephone Number	:	773-382-1224
Fax Number	:	773-362-1085

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	CLAUDIA RODRIGUEZ
Credential	:	MD
Telephone Number	:	773-382-1224

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	12/20/2011

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Directions to “THE WOMEN INSTITUTE SC ” Practice Location

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