Mavena Chicago Clinic, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MAVENA CHICAGO CLINIC, INC.

Practice address

1455 E Golf Rd Ste 120
Des Plaines, IL 60016-1253

Phone

(847) 298-9400

Fax

(847) 298-7660

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Jerri McGinnis

Title

Vice President

Phone

(847) 298-9400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801960208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N MICHIGAN AVE STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113775",
            "telephone_number": "847-298-9400",
            "fax_number": "847-298-7660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 E GOLF RD STE 120",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161253",
            "telephone_number": "847-298-9400",
            "fax_number": "847-298-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVENA CHICAGO CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCGINNIS",
        "authorized_official_first_name": "JERRI",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "847-298-9400"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Des Plaines, IL
• Providers in Des Plaines, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.