Provider Demographics
NPI:1063502813
Name:CENTER FOR WOMEN
Entity Type:Organization
Organization Name:CENTER FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALEXANDRE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:708-343-2095
Mailing Address - Street 1:1419 W LAKE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:708-343-2095
Mailing Address - Fax:708-343-2116
Practice Address - Street 1:1419 W LAKE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-343-2095
Practice Address - Fax:708-343-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00097419OtherRR MEDICARE