1811035462 NPI number — VASECTOMY CLINICS OF CHICAGO

Table of content: MRS. GINA FAY CHRISTOPHER ARNP (NPI 1679729248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811035462 NPI number — VASECTOMY CLINICS OF CHICAGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASECTOMY CLINICS OF CHICAGO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIUMARS MOSTOWFI, M.D., S.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811035462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 669
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-0669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-528-9068
Provider Business Mailing Address Fax Number:
312-278-4492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 N LAKE SHORE DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-528-9068
Provider Business Practice Location Address Fax Number:
312-278-4492
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOSTOWFI
Authorized Official First Name:
KIUMARS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-528-9068

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  036046251 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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