Provider Demographics
NPI:1417954439
Name:ASSOCIATES IN OB-GYN SC
Entity Type:Organization
Organization Name:ASSOCIATES IN OB-GYN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-825-7030
Mailing Address - Street 1:PO BOX 8379
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-7967
Mailing Address - Country:US
Mailing Address - Phone:847-825-7030
Mailing Address - Fax:847-825-7047
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 360
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-825-7030
Practice Address - Fax:847-825-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL456290Medicare PIN