Provider Demographics
NPI:1124056700
Name:MELROSE PARK WOMEN'S CARE, S.C.
Entity type:Organization
Organization Name:MELROSE PARK WOMEN'S CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:B
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-344-7800
Mailing Address - Street 1:PO BOX 95763
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-0763
Mailing Address - Country:US
Mailing Address - Phone:708-344-7800
Mailing Address - Fax:708-344-7804
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:847-839-8800
Practice Address - Fax:847-839-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635364OtherBCBS
IL=========OtherTAX ID
IL1635364OtherBCBS