Provider Demographics
NPI:1750502464
Name:FERTILITY & REPRODUCTIVE ENDOCRINOLOGY SPECIALISTS
Entity type:Organization
Organization Name:FERTILITY & REPRODUCTIVE ENDOCRINOLOGY SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-986-3737
Mailing Address - Street 1:973 FEATHERSTONE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5912
Mailing Address - Country:US
Mailing Address - Phone:815-986-3737
Mailing Address - Fax:815-986-3748
Practice Address - Street 1:973 FEATHERSTONE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5912
Practice Address - Country:US
Practice Address - Phone:815-986-3737
Practice Address - Fax:815-986-3748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG24428Medicare UPIN
ILF62184Medicare UPIN