Provider Demographics
NPI:1811138068
Name:WOMENS DOC OF ELK GROVE SC
Entity type:Organization
Organization Name:WOMENS DOC OF ELK GROVE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMESOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-839-8800
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 535, SIDE 2
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-839-8800
Mailing Address - Fax:847-839-8808
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:SUITE 620
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7220
Practice Address - Country:US
Practice Address - Phone:847-839-4000
Practice Address - Fax:847-839-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI28547Medicare UPIN