MEDICARE: GYNECOLOGICAL & OBSTETRIC ASSOCS, 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	207V00000X	Obstetrics & Gynecology Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01616450	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1982600466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GYNECOLOGICAL & OBSTETRIC ASSOCS, S.C.

Provider Business Mailing Address
First Line	:	675 W CENTRAL RD
Second Line	:	STE 100A
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-2374
Country	:	US
Telephone Number	:	847-392-9191
Fax Number	:	847-392-9811

Provider Business Practice Location Address
First Line	:	1614 W CENTRAL RD STE 205
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005
Country	:	US
Telephone Number	:	847-392-9191
Fax Number	:	847-392-9811

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LORRAINE S NOVAS
Credential	:	M.D.
Telephone Number	:	847-392-9174

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/21/2022

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