Provider Demographics
NPI:1194903518
Name:MIDWEST CENTER FOR WOMEN'S HEALTH
Entity type:Organization
Organization Name:MIDWEST CENTER FOR WOMEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASLIANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-697-9200
Mailing Address - Street 1:PO BOX 1363
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-8363
Mailing Address - Country:US
Mailing Address - Phone:262-697-9200
Mailing Address - Fax:262-697-9206
Practice Address - Street 1:10222 74TH ST STE 200
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-6810
Practice Address - Country:US
Practice Address - Phone:262-697-9200
Practice Address - Fax:262-697-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071201Medicaid
IL036071201Medicaid