Provider Demographics
NPI:1982600466
Name:GYNECOLOGICAL & OBSTETRIC ASSOCS, S.C.
Entity Type:Organization
Organization Name:GYNECOLOGICAL & OBSTETRIC ASSOCS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NOVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-392-9174
Mailing Address - Street 1:675 W CENTRAL RD
Mailing Address - Street 2:STE 100A
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2374
Mailing Address - Country:US
Mailing Address - Phone:847-392-9191
Mailing Address - Fax:847-392-9811
Practice Address - Street 1:1614 W CENTRAL RD STE 205
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-392-9191
Practice Address - Fax:847-392-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01616450OtherBC/BS
675390Medicare PIN