Healthcare Provider Details

I. General information

NPI: 1508242629
Provider Name (Legal Business Name): ILLIANA HOME PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 SIBLEY BLVD
CALUMET CITY IL
60409-2217
US

IV. Provider business mailing address

1609 SIBLEY BLVD
CALUMET CITY IL
60409-2217
US

V. Phone/Fax

Practice location:
  • Phone: 773-359-4757
  • Fax:
Mailing address:
  • Phone: 773-359-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036087374
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number036087374
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES BECKETT
Title or Position: MANAGER
Credential: M.D.
Phone: 773-359-4757