Provider Demographics
NPI:1235499369
Name:NORTHWESTERN OBSTETRICS AND GYNECOLOGY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:NORTHWESTERN OBSTETRICS AND GYNECOLOGY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-642-9844
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:#1880
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-642-9844
Mailing Address - Fax:312-642-7637
Practice Address - Street 1:1535 LAKE COOK ROAD
Practice Address - Street 2:SUITE 604
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:312-642-9844
Practice Address - Fax:312-642-7637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWESTERN OBSTETRICS AND GYNECOLOGY CONSULTANTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty