Organization
LAUREEN L AMBROSE MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAUREEN AMBROSE (M.D.)
(708) 460-1040
Entity
Organization
Contact information
Practice address
15300 WEST AVE, SUITE 205, ORLAND PARK, IL 60462-4600
(708) 460-1040
(708) 460-6872
Mailing address
15300 WEST AVE, SUITE 205, ORLAND PARK, IL 60462-4600
(708) 460-1040
(708) 460-6872
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-059550
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31600367
BLUECROSS & BLUESHIELD
IL
01
—
718990
MEDICARE
IL
Enumeration date
09/16/2010
Last updated
04/01/2011
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