Healthcare Provider Details

I. General information

NPI: 1730899584
Provider Name (Legal Business Name): OASIS HOUSE CALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 W AIRE LIBRE AVE
PEORIA AZ
85382-3987
US

IV. Provider business mailing address

8550 S HARLEM AVE STE G
BRIDGEVIEW IL
60455-1775
US

V. Phone/Fax

Practice location:
  • Phone: 815-953-6422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAHUL DEEPANKER
Title or Position: PHYSICIAN
Credential: MD
Phone: 815-953-6422