Provider Demographics
NPI:1912161100
Name:TOGETHER WOMEN'S HEALTH MEDICAL GROUP OF ILLINOIS, PLLC
Entity Type:Organization
Organization Name:TOGETHER WOMEN'S HEALTH MEDICAL GROUP OF ILLINOIS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NYKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-956-6748
Mailing Address - Street 1:PO BOX 35567
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0633
Mailing Address - Country:US
Mailing Address - Phone:312-775-1100
Mailing Address - Fax:312-775-1111
Practice Address - Street 1:900 N KINGSBURY ST
Practice Address - Street 2:SUITE 130N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7432
Practice Address - Country:US
Practice Address - Phone:312-775-1100
Practice Address - Fax:312-775-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty