Provider Demographics
NPI:1013014042
Name:GYNECOLOGIC SPECIALISTS OF NORTHWESTERN, S.C.
Entity Type:Organization
Organization Name:GYNECOLOGIC SPECIALISTS OF NORTHWESTERN, S.C.
Other - Org Name:OBSTETRIC AND GYNOCOLOGIC SPECIALISTS OF NORTHWESTERN S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-654-1166
Mailing Address - Street 1:190 E DELAWARE PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1814
Mailing Address - Country:US
Mailing Address - Phone:312-654-5292
Mailing Address - Fax:312-654-5588
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-654-1166
Practice Address - Fax:312-654-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty