MEDICARE: NOTHWESTERN REPRODUCTIVE GENETICS

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	207SG0205X	Ph.D. Medical Genetics Physician

General Provider Information

NPI Number	:	1588748404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOTHWESTERN REPRODUCTIVE GENETICS

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-981-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	STE 1428
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-981-4400
Fax Number	:

Authorized Official
Title or Position	:	PYSICIAN
Name	:	EUGENE PERGAMENT
Credential	:	M.D.
Telephone Number	:	847-429-0571

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/21/2018

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