# NANCY R G CHURCH MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881960961
- **Authorized official:** NANCY R CHURCH M D (OWNER)
- **Authorized official phone:** (773) 233-6500

## Contact information

- **Practice address:** 10725 S WESTERN AVE, CHICAGO, IL 60643-3135
- **Practice address phone:** (773) 233-6500
- **Practice address fax:** (773) 233-2369
- **Mailing address:** 10725 S WESTERN AVE, CHICAGO, IL 60643-3135
- **Mailing address phone:** (773) 233-6500
- **Mailing address fax:** (773) 233-2369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 036085259 | IL | Yes |

## Other

- **Enumeration date:** 03/22/2012
- **Last updated:** 03/22/2012