Provider Demographics
NPI:1609907344
Name:COMPREHENSIVE CENTER FOR WOMENS MEDICINE LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE CENTER FOR WOMENS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COCKERILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:773-435-1150
Mailing Address - Street 1:1 E DELAWARE PL
Mailing Address - Street 2:501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1449
Mailing Address - Country:US
Mailing Address - Phone:773-435-1150
Mailing Address - Fax:773-435-1330
Practice Address - Street 1:1 E DELAWARE PL
Practice Address - Street 2:501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1449
Practice Address - Country:US
Practice Address - Phone:773-435-1150
Practice Address - Fax:773-435-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1630135OtherBLUE CROSS BLUE SHIELD
IL1630135OtherBLUE CROSS BLUE SHIELD