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Organization
LIBERTYVILLE OBGYN S.C.
Active
Organization
LIBERTYVILLE OBGYN S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENZO PADOVANO (PRESIDENT)
(847) 367-0022
Entity
Organization
Contact information
Practice address
890 GARFIELD AVE, 104, LIBERTYVILLE, IL 60048-4723
(847) 367-0022
(847) 680-0696
Mailing address
890 GARFIELD AVE, 104, LIBERTYVILLE, IL 60048-4723
(847) 367-0022
(847) 680-0696
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
042617217
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042617217
REGISTERED MEDICAL CORP
IL
01
—
04923732
BCBS
IL
Enumeration date
01/09/2007
Last updated
02/13/2013
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