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NPI Code Detail

MEDICARE: THEODORE MORRISON HOMA MD

MEDICARE: THEODORE MORRISON HOMA MD
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
1207R00000XInternal Medicine Physician036-050063IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110227219OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036050063OTHERILLICENSE #

General Provider Information

NPI Number : 1699710483
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE MORRISON HOMA MD
Provider Business Mailing Address
First Line : 765 ELA RD
Second Line : STE 201
City : LAKE ZURICH
State : IL
Zip : 60047-6305
Country : US
Telephone Number : 847-222-9901
Fax Number : 847-222-9904
Provider Business Practice Location Address
First Line : 800 W OAKTON ST
Second Line :
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004-4602
Country : US
Telephone Number : 847-222-9901
Fax Number : 847-222-9904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2006
Last Update Date : 05/13/2020

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