Provider Demographics
NPI:1407078801
Name:THE INSTITUTE FOR HUMAN REPRODUCTION
Entity Type:Organization
Organization Name:THE INSTITUTE FOR HUMAN REPRODUCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-288-6420
Mailing Address - Street 1:680 N LAKE SHORE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4448
Mailing Address - Country:US
Mailing Address - Phone:312-288-6420
Mailing Address - Fax:312-288-6421
Practice Address - Street 1:680 N LAKE SHORE DR STE 117
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4448
Practice Address - Country:US
Practice Address - Phone:312-288-6420
Practice Address - Fax:312-288-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1528166626OtherNATIONAL PROVIDER IDENTIFIER
IL1093745366OtherNATIONAL PROVIDER IDENTIFIER
IL1134166531OtherNATIONAL PROVIDER IDENTIFIER