Provider Demographics
NPI:1568651339
Name:NORTHWEST OB/GYN CONSULTING
Entity Type:Organization
Organization Name:NORTHWEST OB/GYN CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEVELEV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-419-1900
Mailing Address - Street 1:201 E STRONG ST
Mailing Address - Street 2:STE 9
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2979
Mailing Address - Country:US
Mailing Address - Phone:847-419-1900
Mailing Address - Fax:
Practice Address - Street 1:201 E STRONG ST
Practice Address - Street 2:STE 9
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2979
Practice Address - Country:US
Practice Address - Phone:847-419-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208187Medicare PIN