Provider Demographics
NPI:1306913454
Name:CHICAGO METROPOLITAN OBSTETRICIANS & GYNECOLOGISTS, LTD
Entity type:Organization
Organization Name:CHICAGO METROPOLITAN OBSTETRICIANS & GYNECOLOGISTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-333-3030
Mailing Address - Street 1:PO BOX 4685
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4685
Mailing Address - Country:US
Mailing Address - Phone:708-333-3030
Mailing Address - Fax:708-333-7453
Practice Address - Street 1:15620 S. WOOD STREET
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4171
Practice Address - Country:US
Practice Address - Phone:708-333-3030
Practice Address - Fax:708-333-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
IL036043976207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100768 JAMESMedicaid
IL036110499 REDHEADMedicaid
IL1447283445OtherNPI NUMBER REDHEAD
IL01630253OtherBLUE CROSS BLUE SHIELD
IL036043976Medicaid
IL1306913454OtherCMOB NPI NUMBER
IL1659385128OtherNPI NUMBER JAMES
IL212568OtherMEDICARE GROUP PIN
IL207V00000XOtherPROVIDERS TAXONOMIES
IL212568OtherMEDICARE GROUP NUMBER
IL01630253OtherBLUE CROSS BLUE SHIELD
IL1659385128OtherNPI NUMBER JAMES
IL207V00000XOtherPROVIDERS TAXONOMIES