NPIMap

Organization Active NPI

Illinois Urogynecology, LTD.

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Park Ridge, IL
National Provider Identifier
1063421899
Registry record updated Jun 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
Legal business name
ILLINOIS UROGYNECOLOGY, LTD.
Practice address
1875 Dempster St
Suite 665
Park Ridge, IL 60068-1186
Phone
(847) 825-1590
Fax
(847) 825-1604
NPI assigned
Aug 8, 2006
Last updated
Jun 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Moen, MDNPI 1558351312
Title
Pres
Phone
(847) 825-1590

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X IL
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X IL Primary

Addresses

Primary practice location

1875 Dempster St
Suite 665
Park Ridge, IL 60068-1186

Mailing address

1875 Dempster St
Suite 665
Park Ridge, IL 60068-1186
Phone (847) 825-1590

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318000115 IL Part B Supplier - Clinic/Group Practice 0840180303 Receives reassigned benefits from 6 practitioners
Practice locations: Libertyville, IL; Lisle, IL; Naperville, IL; Park Ridge, IL; Sandwich, IL; Skokie, IL; Arlington Heights, IL; Winfield, IL…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1039338Illinois Urogynecology LTD1875 Dempster St - Suite 665, Park Ridge, IL 60068Certificate of waiverApr 11, 2027

National Provider Directory

National Provider Directory

Locations

880 W Central Rd
Fl 3
Arlington Heights, IL 60005
Phone (847) 618-0950

2088 Ogden Ave
Ste 260
Aurora, IL 60504
Phone (630) 375-9499

1200 S York St
Ste 4250
Elmhurst, IL 60126
Phone (630) 317-7682

1555 N Barrington Rd
#3
Hoffman Estates, IL 60169
Phone (847) 490-2773

120 Spalding Dr
Ste 305
Naperville, IL 60540
Phone (630) 527-5120

1875 W Dempster St
Ste 665
Park Ridge, IL 60068

25 N Winfield Rd
#419
Winfield, IL 60190
Phone (630) 933-6091

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781568000000",
    "number": "1063421899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 DEMPSTER ST",
            "address_2": "SUITE 665",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681186",
            "telephone_number": "847-825-1590",
            "fax_number": "847-825-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 DEMPSTER ST",
            "address_2": "SUITE 665",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681186",
            "telephone_number": "847-825-1590",
            "fax_number": "847-825-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS UROGYNECOLOGY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A",
        "authorized_official_last_name": "MOEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "847-825-1590",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.