Healthcare Provider Details

I. General information

NPI: 1841218740
Provider Name (Legal Business Name): IN HOME DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 N. ELSTON AVE. SUITE 116
CHICAGO IL
60618-5811
US

IV. Provider business mailing address

3319 N. ELSTON AVE. SUITE 116
CHICAGO IL
60618-5811
US

V. Phone/Fax

Practice location:
  • Phone: 773-751-7325
  • Fax: 773-583-4401
Mailing address:
  • Phone: 773-751-7325
  • Fax: 773-583-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: DAVID EVANS
Title or Position: CEO
Credential:
Phone: 773-751-7325