Provider Demographics
NPI:1528146909
Name:OUR OBGYN, S.C.
Entity type:Organization
Organization Name:OUR OBGYN, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARMADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPUSWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-390-1240
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:SUITE 303, TOWER II
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-390-1240
Mailing Address - Fax:630-390-1247
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 303, TOWER II
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-390-1240
Practice Address - Fax:630-390-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214438Medicare ID - Type Unspecified
ILC50043Medicare UPIN