Provider Demographics
NPI:1679844039
Name:ADVANCED GYNECOLOGY, S.C.
Entity Type:Organization
Organization Name:ADVANCED GYNECOLOGY, S.C.
Other - Org Name:ADVANCED GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SOGOL
Authorized Official - Middle Name:JAHEDI
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-568-1488
Mailing Address - Street 1:250 W KENSINGTON RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1292
Mailing Address - Country:US
Mailing Address - Phone:847-568-1488
Mailing Address - Fax:847-749-2695
Practice Address - Street 1:250 W KENSINGTON RD STE 1B
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1292
Practice Address - Country:US
Practice Address - Phone:847-568-1488
Practice Address - Fax:847-749-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-619903207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL042-619903OtherSTATE LICENSE OF MEDICAL CORPORATION