Provider Demographics
NPI:1114144987
Name:THE WOMEN'S GROUP OF NORTHWESTERN
Entity Type:Organization
Organization Name:THE WOMEN'S GROUP OF NORTHWESTERN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:MARA
Authorized Official - Last Name:KAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-440-4162
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 1317
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-440-3810
Mailing Address - Fax:312-440-3812
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 1317
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-440-3810
Practice Address - Fax:312-440-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN