Provider Demographics
NPI:1164616389
Name:CONTEMPORARY OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:CONTEMPORARY OBSTETRICS & GYNECOLOGY PC
Other - Org Name:CONTEMPORARY OB/GYN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:309-663-0411
Mailing Address - Street 1:2304 STERN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4487
Mailing Address - Country:US
Mailing Address - Phone:309-663-0411
Mailing Address - Fax:309-662-2018
Practice Address - Street 1:2304 STERN DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4487
Practice Address - Country:US
Practice Address - Phone:309-663-0411
Practice Address - Fax:309-662-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5732148OtherBCBS GROUP
IL216064OtherMEDICARE GROUP