Provider Demographics
NPI:1396142857
Name:ILLINOIS INSTITUTE OF GYNECOLOGY AND ADVANCED PELVIC SURGERY, SC
Entity type:Organization
Organization Name:ILLINOIS INSTITUTE OF GYNECOLOGY AND ADVANCED PELVIC SURGERY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ADAJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-428-0624
Mailing Address - Street 1:1351 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7195
Mailing Address - Country:US
Mailing Address - Phone:312-785-8881
Mailing Address - Fax:312-956-2733
Practice Address - Street 1:1351 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7195
Practice Address - Country:US
Practice Address - Phone:312-785-8881
Practice Address - Fax:312-956-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-28
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124772207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1730318148OtherPROVIDER NPI NUMBER
ILF400193284Medicare PIN
ILF100193117Medicare PIN