Healthcare Provider Details

I. General information

NPI: 1144525510
Provider Name (Legal Business Name): AMERICAN HOME VISITING PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 E GOLF RD
DES PLAINES IL
60016-2349
US

IV. Provider business mailing address

PO BOX 578220
CHICAGO IL
60657-8121
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-3141
  • Fax:
Mailing address:
  • Phone: 847-833-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. NANNETTE LAINO
Title or Position: OWNER
Credential: APN
Phone: 847-833-4560