Provider Demographics
NPI:1477741320
Name:WOMENS CENTER OF NORTHERN ILLINOIS
Entity Type:Organization
Organization Name:WOMENS CENTER OF NORTHERN ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JYOTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GONDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-323-1133
Mailing Address - Street 1:6532 SPRING BROOK RD APT 203
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8135
Mailing Address - Country:US
Mailing Address - Phone:815-323-1133
Mailing Address - Fax:
Practice Address - Street 1:303 ANDREWS DR
Practice Address - Street 2:200
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3918
Practice Address - Country:US
Practice Address - Phone:815-323-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty