Healthcare Provider Details

I. General information

NPI: 1578665907
Provider Name (Legal Business Name): HOME HEALTH MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SOUTHWEST HWY
OAK LAWN IL
60453-3724
US

IV. Provider business mailing address

9900 SOUTHWEST HWY
OAK LAWN IL
60453-3724
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-7758
  • Fax: 708-422-8154
Mailing address:
  • Phone: 708-422-7758
  • Fax: 708-422-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036094623
License Number StateIL

VIII. Authorized Official

Name: DR. RONALD ERIC SAM
Title or Position: SOLE MANAGER/PHYSICIAN
Credential: D.O.
Phone: 708-422-7758