Provider Demographics
NPI:1194758375
Name:M & A OB-GYN ASSOCIATES, SC
Entity type:Organization
Organization Name:M & A OB-GYN ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:AHRANJANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-282-5299
Mailing Address - Street 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4401
Mailing Address - Country:US
Mailing Address - Phone:773-282-5299
Mailing Address - Fax:773-282-5504
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:SUITE 503
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4401
Practice Address - Country:US
Practice Address - Phone:773-282-5299
Practice Address - Fax:773-282-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0930527OtherCLIA
ILDQ2132OtherRAILROAD MEDICARE
IL01627922OtherBCBS
IL917480Medicare PIN