Provider Demographics
NPI:1740488980
Name:OB-GYNE& INFERTILITY CENTER, S.C.
Entity type:Organization
Organization Name:OB-GYNE& INFERTILITY CENTER, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KUNANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-228-9898
Mailing Address - Street 1:901 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3392
Mailing Address - Country:US
Mailing Address - Phone:847-228-9898
Mailing Address - Fax:847-228-9899
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-228-9898
Practice Address - Fax:847-228-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 207RR0500X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113949Medicaid
IL385128OtherHARMONY
IL0001635769OtherBLUE CROSS BLUE SHIELD
IL212703Medicare PIN
IL036113949Medicaid