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Organization

OBSTETRICS & GYNECOLOGY PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MAUREEN PENDL (ACCOUNT MANAGER)
(312) 440-1600
Entity
Organization

Contact information

Practice address
680 N LAKE SHORE DR, SUITE 830, CHICAGO, IL 60611-4546
(312) 440-1600
(312) 440-3508
Mailing address
680 N LAKE SHORE DR, SUITE 830, CHICAGO, IL 60611-4546
(312) 440-1600
(312) 440-3508

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
060003474
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01617247
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/22/2007
Last updated
10/29/2009
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