Provider Demographics
NPI:1205837119
Name:WOMEN FIRST SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:WOMEN FIRST SPECIALISTS, S.C.
Other - Org Name:WOMEN FIRST SPECIALISTS, S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYNELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-792-0209
Mailing Address - Street 1:6121 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4703
Mailing Address - Country:US
Mailing Address - Phone:773-792-0209
Mailing Address - Fax:773-792-0112
Practice Address - Street 1:6121 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4703
Practice Address - Country:US
Practice Address - Phone:773-792-0209
Practice Address - Fax:773-792-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36059468207V00000X
IL36087120207V00000X
IL36112532207VX0000X
IL36122486207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36087120Medicaid
IL36112532Medicaid
IL36122486Medicaid
IL1205837119OtherBCBS OF ILLINOIS
IL36059468Medicaid
IL036112532Medicaid
IL36087120Medicaid
ILK21961Medicare ID - Type UnspecifiedJOZEF F. MAZUREK, M.D.
ILI44272Medicare UPIN
IL036112532Medicaid