Healthcare Provider Details

I. General information

NPI: 1811998438
Provider Name (Legal Business Name): HOME PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S DAMEN AVE SUITE 210
CHICAGO IL
60608-1169
US

IV. Provider business mailing address

1340 S DAMEN AVE STE 400
CHICAGO IL
60608-1169
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-4800
  • Fax: 773-384-7053
Mailing address:
  • Phone: 773-292-4800
  • Fax: 773-384-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL FESSENDEN
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 615-401-4634