Provider Demographics
NPI:1548256506
Name:CHICAGO GYNECOLOGIC ONCOLOGY, S.C.
Entity type:Organization
Organization Name:CHICAGO GYNECOLOGIC ONCOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BANU
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-490-0144
Mailing Address - Street 1:120 W GOLF RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-5179
Mailing Address - Country:US
Mailing Address - Phone:847-490-0144
Mailing Address - Fax:847-430-1236
Practice Address - Street 1:120 W GOLF RD
Practice Address - Street 2:SUITE 212
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-5179
Practice Address - Country:US
Practice Address - Phone:847-490-0144
Practice Address - Fax:847-490-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-047122174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047122Medicaid
IL036047122Medicaid
IL=========OtherTAX ID NUMBER
ILD13673Medicare UPIN
IL036047122Medicaid