Healthcare Provider Details

I. General information

NPI: 1760575310
Provider Name (Legal Business Name): AMERICAN HOME PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5962 N. LINCOLN AVE SUITE NUMBER 3
CHICAGO IL
60659
US

IV. Provider business mailing address

5962 N. LINCOLN AVE SUITE NUMBER 3
CHICAGO IL
60659
US

V. Phone/Fax

Practice location:
  • Phone: 773-744-7864
  • Fax:
Mailing address:
  • Phone: 773-744-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRZA A BAIG
Title or Position: VP
Credential:
Phone: 773-744-7864