Provider Demographics
NPI:1033604525
Name:MWM MEDICAL, SC
Entity Type:Organization
Organization Name:MWM MEDICAL, SC
Other - Org Name:CENTER FOR REPRODUCTIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD MOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-718-2229
Mailing Address - Street 1:341 W WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5636
Mailing Address - Country:US
Mailing Address - Phone:312-718-2229
Mailing Address - Fax:773-248-7630
Practice Address - Street 1:1725 W HARRISON ST STE 408
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3852
Practice Address - Country:US
Practice Address - Phone:312-718-2229
Practice Address - Fax:773-248-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty