Healthcare Provider Details

I. General information

NPI: 1235456591
Provider Name (Legal Business Name): HOUSE CALLS CHICAGO CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8836 S ASHLAND AVE
CHICAGO IL
60620-4956
US

IV. Provider business mailing address

8539 S SAGINAW AVE
CHICAGO IL
60617-2444
US

V. Phone/Fax

Practice location:
  • Phone: 773-629-6036
  • Fax: 773-629-6852
Mailing address:
  • Phone: 708-699-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH S NAVE
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 708-699-0293