Provider Demographics
NPI:1316155419
Name:FERTILITY ENDOCRINE & ANDROLOGY CONSULTANTS LLC
Entity type:Organization
Organization Name:FERTILITY ENDOCRINE & ANDROLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELWYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-942-2400
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 739
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-2400
Mailing Address - Fax:312-942-2485
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 739
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-2400
Practice Address - Fax:312-942-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL97843Medicare ID - Type Unspecified