Provider Demographics
NPI:1396014288
Name:MIDWEST PERINATAL CONSULTANTS, SC
Entity Type:Organization
Organization Name:MIDWEST PERINATAL CONSULTANTS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOGURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-783-8975
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:ELGI
Mailing Address - State:IL
Mailing Address - Zip Code:60121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 N RANDALL RD
Practice Address - Street 2:SHERMAN HOSP, SUITE 1-2150
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2300
Practice Address - Country:US
Practice Address - Phone:224-783-8975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124176987OtherINDIVIDUAL NPI