Provider Demographics
NPI:1356016224
Name:MYMENOPAUSERX MEDICAL GROUP
Entity Type:Organization
Organization Name:MYMENOPAUSERX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:855-444-6679
Mailing Address - Street 1:1604 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3145
Mailing Address - Country:US
Mailing Address - Phone:855-444-6679
Mailing Address - Fax:833-740-1146
Practice Address - Street 1:1604 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3145
Practice Address - Country:US
Practice Address - Phone:855-444-6679
Practice Address - Fax:833-740-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty