Provider Type Icon

WESTERN DUPAGE OBSTETRICS & GYNECOLOGY SC NPI 1609921170


NPI Information

NPI: 1609921170
Provider Name: WESTERN DUPAGE OBSTETRICS & GYNECOLOGY SC
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 14D0867481

Address:
3540 SEVEN BRIDGES DR STE 200
WOODRIDGE, IL
ZIP 60517
Phone: (630) 810-0777
Get Directions

WESTERN DUPAGE OBSTETRICS & GYNECOLOGY SC is an obstetrics gynecology in Woodridge, IL. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. WESTERN DUPAGE OBSTETRICS & GYNECOLOGY SC NPI is 1609921170. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3540 SEVEN BRIDGES DR STE 200
WOODRIDGE, IL
ZIP 60517-222
Phone: (630) 810-0777
Fax: (630) 810-0395

The provider's authorized official is George A Banuelos .
The authorized official title is Medical Doctor/president and has the following contact phone number (630) 810-0777.

The CLIA number assigned to this NPI record is 14D0867481 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/24/2007 and was last updated on 12/20/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12201686OTHERILLINOISBCBS ILLINOIS PROVIDER #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.