MEDICARE: CENTER FOR GYNECOLOGY AND COSMETICS, LTD

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	207V00000X	Obstetrics & Gynecology Physician	036-122006	IL

General Provider Information

NPI Number	:	1700292455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR GYNECOLOGY AND COSMETICS, LTD

Provider Business Mailing Address
First Line	:	820 W JACKSON BLVD
Second Line	:	SUITE 310
City	:	CHICAGO
State	:	IL
Zip	:	60607-3026
Country	:	US
Telephone Number	:	312-574-3434
Fax Number	:	312-724-7647

Provider Business Practice Location Address
First Line	:	820 W JACKSON BLVD
Second Line	:	SUITE 310
City	:	CHICAGO
State	:	IL
Zip	:	60607-3026
Country	:	US
Telephone Number	:	312-574-3434
Fax Number	:	312-724-7647

Authorized Official
Title or Position	:	OWNER/MEDICAL DIRECTOR
Name	:	DR. SAMEENA A RAHMAN
Credential	:	M.D.
Telephone Number	:	312-574-3434

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	07/02/2014

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