Provider Demographics
NPI:1164566345
Name:COMPREHENSIVE WOMENS CENTER
Entity Type:Organization
Organization Name:COMPREHENSIVE WOMENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHLIPALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-808-7070
Mailing Address - Street 1:1083 E LAKE COOK RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2502
Mailing Address - Country:US
Mailing Address - Phone:847-808-7070
Mailing Address - Fax:847-808-7474
Practice Address - Street 1:1083 E LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2502
Practice Address - Country:US
Practice Address - Phone:847-808-7070
Practice Address - Fax:847-808-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617403174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06123696OtherBCBS
IL036091075Medicaid
IL06123696OtherBCBS