Provider Demographics
NPI:1114318474
Name:GYNECOLOGICAL CANCER INSTITUTE OF CHICAGO, LLC
Entity Type:Organization
Organization Name:GYNECOLOGICAL CANCER INSTITUTE OF CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUIRGUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-347-0595
Mailing Address - Street 1:6700 W 95TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2416
Mailing Address - Country:US
Mailing Address - Phone:708-422-3242
Mailing Address - Fax:708-422-3243
Practice Address - Street 1:6700 W 95TH ST STE 330
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2416
Practice Address - Country:US
Practice Address - Phone:708-422-3242
Practice Address - Fax:708-422-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108495207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK44986Medicare PIN