Provider Demographics
NPI:1114341567
Name:CHICAGO CENTER FOR WOMENS HEALTH SC
Entity Type:Organization
Organization Name:CHICAGO CENTER FOR WOMENS HEALTH SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MOLINA
Authorized Official - Last Name:FURLONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-414-5670
Mailing Address - Street 1:6433 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5148
Mailing Address - Country:US
Mailing Address - Phone:773-414-5670
Mailing Address - Fax:773-585-7590
Practice Address - Street 1:6433 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5148
Practice Address - Country:US
Practice Address - Phone:773-414-5670
Practice Address - Fax:773-585-7590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110737261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty