Provider Demographics
NPI:1194709931
Name:CONSULTANTS IN GYNECOLOGY, S.C.
Entity type:Organization
Organization Name:CONSULTANTS IN GYNECOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-663-1054
Mailing Address - Street 1:5747 DEMPSTER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3056
Mailing Address - Country:US
Mailing Address - Phone:847-663-1030
Mailing Address - Fax:847-663-1039
Practice Address - Street 1:5747 DEMPSTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3056
Practice Address - Country:US
Practice Address - Phone:847-663-1030
Practice Address - Fax:847-663-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036080243207VG0400X
IL036056308207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL360220Medicare PIN