Provider Demographics
NPI:1013135771
Name:WOMENS HEALTHCARE ASSOCIATES OF IL, SC
Entity Type:Organization
Organization Name:WOMENS HEALTHCARE ASSOCIATES OF IL, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-799-6450
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1085
Mailing Address - Country:US
Mailing Address - Phone:708-799-6450
Mailing Address - Fax:708-799-6560
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-799-6450
Practice Address - Fax:708-799-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108162207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209221Medicare PIN