Provider Demographics
NPI:1619962859
Name:NORTHERN ILLINOIS FERTILITY SC
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS FERTILITY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-758-8621
Mailing Address - Street 1:625 BETHANY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4908
Mailing Address - Country:US
Mailing Address - Phone:815-758-8621
Mailing Address - Fax:815-758-5838
Practice Address - Street 1:625 BETHANY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4908
Practice Address - Country:US
Practice Address - Phone:815-758-8621
Practice Address - Fax:815-758-5838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X, 363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212788Medicare PIN