Healthcare Provider Details

I. General information

NPI: 1689809170
Provider Name (Legal Business Name): HOME AND WOUND CARE PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8328 LINCOLN AVE
SKOKIE IL
60077-2436
US

IV. Provider business mailing address

8328 LINCOLN AVE
SKOKIE IL
60077-2436
US

V. Phone/Fax

Practice location:
  • Phone: 847-626-0026
  • Fax: 847-677-0028
Mailing address:
  • Phone: 847-626-0026
  • Fax: 847-677-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CIELO RAMIREZ
Title or Position: PRESIDENT
Credential:
Phone: 847-626-0026