MEDICARE: HOUSE CALL MD 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1902245368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE CALL MD LLC

Provider Business Mailing Address
First Line	:	350 W KENSINGTON RD
Second Line	:	SUITE 120
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-222-9595
Fax Number	:	847-222-9565

Provider Business Practice Location Address
First Line	:	350 W KENSINGTON RD
Second Line	:	SUITE 120
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-222-9595
Fax Number	:	847-222-9565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BINO OOMMEN
Credential	:	M.D.
Telephone Number	:	847-222-9595

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	06/19/2013

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