Provider Demographics
NPI:1619225174
Name:CHICAGO OB-GYN ULTRASOUND SC
Entity Type:Organization
Organization Name:CHICAGO OB-GYN ULTRASOUND SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABRAMOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-322-7382
Mailing Address - Street 1:2825 N HALSTED ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5105
Mailing Address - Country:US
Mailing Address - Phone:773-322-7382
Mailing Address - Fax:773-935-3691
Practice Address - Street 1:2825 N HALSTED ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5105
Practice Address - Country:US
Practice Address - Phone:773-322-7382
Practice Address - Fax:773-935-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101996207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101996OtherILLINOIS STATE LICENSE