Healthcare Provider Details

I. General information

NPI: 1811310956
Provider Name (Legal Business Name): HOMSI PEDIATRIC NEUROLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2014
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NANDINA CT
BOLINGBROOK IL
60490-2121
US

IV. Provider business mailing address

4 NANDINA CT
BOLINGBROOK IL
60490-2121
US

V. Phone/Fax

Practice location:
  • Phone: 630-771-0255
  • Fax: 630-771-0255
Mailing address:
  • Phone: 630-771-0255
  • Fax: 630-771-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036112318
License Number StateIL

VIII. Authorized Official

Name: DR. MOHAMMED S HOMSI
Title or Position: PRESIDENT
Credential: MD
Phone: 630-888-0751