Provider Demographics
NPI:1881806719
Name:ADVANCED FERTILITY CENTER OF CHICAGO
Entity type:Organization
Organization Name:ADVANCED FERTILITY CENTER OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERBAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-662-1818
Mailing Address - Street 1:30 TOWER COURT
Mailing Address - Street 2:SUITE F
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-662-1818
Mailing Address - Fax:847-662-3001
Practice Address - Street 1:30 TOWER COURT
Practice Address - Street 2:SUITE F
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-662-1818
Practice Address - Fax:847-662-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086403174400000X
IL036086403207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG13732Medicare UPIN