Provider Demographics
NPI:1427336726
Name:WOMEN'S HEALTH CARE CENTER OF CHICAGO, S.C.
Entity type:Organization
Organization Name:WOMEN'S HEALTH CARE CENTER OF CHICAGO, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADEEB
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSHAHROUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-661-9049
Mailing Address - Street 1:4009 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2103
Mailing Address - Country:US
Mailing Address - Phone:630-415-6996
Mailing Address - Fax:888-289-5746
Practice Address - Street 1:4009 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-2103
Practice Address - Country:US
Practice Address - Phone:630-415-6996
Practice Address - Fax:888-289-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112499Medicaid