Provider Demographics
NPI:1457563272
Name:OB-GYNE ASSOCIATES OF LIBERTYVILLE, SC
Entity Type:Organization
Organization Name:OB-GYNE ASSOCIATES OF LIBERTYVILLE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-680-3400
Mailing Address - Street 1:801 S MILWAUKEE AVENUE, STE 100
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-680-3400
Mailing Address - Fax:847-680-3486
Practice Address - Street 1:801 S MILWAUKEE AVENUE, STE 100
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-680-3400
Practice Address - Fax:847-680-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078559207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04900943OtherBLUE CROSS BLUE SHEILD
IL04900943OtherBLUE CROSS BLUE SHEILD
IL911790L13179Medicare ID - Type Unspecified