Provider Demographics
NPI:1104049782
Name:LIFECIRCLE WOMENS HEALTH SC
Entity type:Organization
Organization Name:LIFECIRCLE WOMENS HEALTH SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-301-6751
Mailing Address - Street 1:7800 W COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1007
Mailing Address - Country:US
Mailing Address - Phone:708-361-2400
Mailing Address - Fax:708-361-2400
Practice Address - Street 1:7800 W COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1007
Practice Address - Country:US
Practice Address - Phone:708-361-2400
Practice Address - Fax:708-361-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty