Provider Demographics
NPI:1649255902
Name:LAKE FOREST OBSTETRICS GYNECOLOGY & INFERTILITY S.C.
Entity type:Organization
Organization Name:LAKE FOREST OBSTETRICS GYNECOLOGY & INFERTILITY S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-234-3860
Mailing Address - Street 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-234-3860
Mailing Address - Fax:847-234-3981
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE 228
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-234-3860
Practice Address - Fax:847-234-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04900441OtherBCBS GROUP PROVIDER NUMBE
IL04900441OtherBCBS GROUP PROVIDER NUMBE