1821130279 NPI number — ALLIED OBGYN LTD

Table of content: (NPI 1821130279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821130279 NPI number — ALLIED OBGYN LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIED OBGYN LTD
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:
Provider Other Organization Name Type Code:
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:
1821130279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 E NORTHWEST HWY
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
PALATINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60074-6509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-991-1400
Provider Business Mailing Address Fax Number:
847-991-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E NORTHWEST HWY
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
PALATINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60074-6509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-991-1400
Provider Business Practice Location Address Fax Number:
847-991-1011
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KANG
Authorized Official First Name:
MINJAH
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-991-1400

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , 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)

  • Identifier: 21604379 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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