Healthcare Provider Details

I. General information

NPI: 1417433574
Provider Name (Legal Business Name): HOUSE CALL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 COURT ST STE B
PEKIN IL
61554-4807
US

IV. Provider business mailing address

5811 W IVYBRIDGE PL
PEORIA IL
61615-9289
US

V. Phone/Fax

Practice location:
  • Phone: 309-642-6705
  • Fax: 309-620-8751
Mailing address:
  • Phone: 314-560-9648
  • Fax: 309-620-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AHSAN USMAN
Title or Position: CEO
Credential: MD
Phone: 314-560-9648