Provider Demographics
NPI:1902095821
Name:VALLEY OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:VALLEY OBSTETRICS & GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVPURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-697-2500
Mailing Address - Street 1:2050 LARKIN AVE
Mailing Address - Street 2:SUITE100
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4405
Mailing Address - Country:US
Mailing Address - Phone:847-697-2500
Mailing Address - Fax:847-697-2565
Practice Address - Street 1:2050 LARKIN AVE
Practice Address - Street 2:SUITE100
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4405
Practice Address - Country:US
Practice Address - Phone:847-697-2500
Practice Address - Fax:847-697-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL550260Medicare PIN