Provider Demographics
NPI:1063449924
Name:OBSTETRICS, GYNECOLOGY & INFERTILITY,S.C.
Entity type:Organization
Organization Name:OBSTETRICS, GYNECOLOGY & INFERTILITY,S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DORINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCAUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-692-9234
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-692-9234
Mailing Address - Fax:847-692-5267
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 245
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-692-9234
Practice Address - Fax:847-692-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL604480Medicare PIN
IL204870Medicare PIN