Provider Demographics
NPI:1649268145
Name:CHICAGO WOMEN'S HEALTHCARE, SC
Entity type:Organization
Organization Name:CHICAGO WOMEN'S HEALTHCARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-326-4500
Mailing Address - Street 1:2600 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2857
Mailing Address - Country:US
Mailing Address - Phone:312-326-4500
Mailing Address - Fax:312-326-1200
Practice Address - Street 1:2600 S MICHIGAN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2857
Practice Address - Country:US
Practice Address - Phone:312-326-4500
Practice Address - Fax:312-326-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096073207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096073Medicaid
IL160059246OtherRAILROAD MEDICARE
IL01632952OtherBCBS
IL209889Medicare PIN
ILH28567Medicare UPIN
ILK10375Medicare PIN
IL209889/K10375Medicare ID - Type Unspecified