Healthcare Provider Details

I. General information

NPI: 1194330977
Provider Name (Legal Business Name): HOME DOCTORS FOR YOU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 ILLINOIS BLVD
HOFFMAN EST IL
60169-3363
US

IV. Provider business mailing address

7331 N LINCOLN AVE STE 15
LINCOLNWOOD IL
60712-1766
US

V. Phone/Fax

Practice location:
  • Phone: 224-201-2389
  • Fax:
Mailing address:
  • Phone: 847-983-8356
  • Fax: 224-251-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE REVITA RUNEZ
Title or Position: PRESIDENT
Credential:
Phone: 224-201-2389