Provider Demographics
NPI:1891425955
Name:PEACE LILY FERTILITY
Entity Type:Organization
Organization Name:PEACE LILY FERTILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KARENNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:FRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-283-1795
Mailing Address - Street 1:160 E TASMAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 PEACHTREE ST NE STE 145
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1895
Practice Address - Country:US
Practice Address - Phone:773-283-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty