Healthcare Provider Details

I. General information

NPI: 1295900322
Provider Name (Legal Business Name): URBAN HOME PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 MADISON ST
OAK PARK IL
60302-4091
US

IV. Provider business mailing address

408 MADISON ST
OAK PARK IL
60302-4091
US

V. Phone/Fax

Practice location:
  • Phone: 708-445-0898
  • Fax: 708-445-0907
Mailing address:
  • Phone: 708-445-0898
  • Fax: 708-445-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number.36078052
License Number StateIL

VIII. Authorized Official

Name: DR. VICTOR L THOMAS
Title or Position: PRESIDENT
Credential: MD
Phone: 708-445-0898