Provider Demographics
NPI:1972786762
Name:SUBURBAN WOMENS HEALTH SPECIALISTS LTD
Entity Type:Organization
Organization Name:SUBURBAN WOMENS HEALTH SPECIALISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-931-4747
Mailing Address - Street 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-931-4747
Mailing Address - Fax:847-931-9602
Practice Address - Street 1:2971 W ALGONQUIN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9406
Practice Address - Country:US
Practice Address - Phone:847-458-2400
Practice Address - Fax:847-458-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007882207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064786Medicaid
IL036093466Medicaid
IL036093466Medicaid
ILE18974Medicare UPIN