MEDICARE: PHYSICIAN HOUSE CALL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1845089	OH
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	1845089	OH
3	213E00000X	Podiatrist	1845089	OH
4	208D00000X	General Practice Physician	1845089	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134362775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN HOUSE CALL SERVICES LLC

Provider Business Mailing Address
First Line	:	402 SANDHURST DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3604
Country	:	US
Telephone Number	:	216-201-0339
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 SANDHURST DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3604
Country	:	US
Telephone Number	:	216-201-0339
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	VYACHESLAV ISAKOV
Credential	:	MD
Telephone Number	:	216-201-0339

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	08/01/2011

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