Healthcare Provider Details

I. General information

NPI: 1417703844
Provider Name (Legal Business Name): NURSING HOME PHYSICIAN GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WINFIELD RD STE 200
WARRENVILLE IL
60555-4023
US

IV. Provider business mailing address

PO BOX 1109
CROWN POINT IN
46308-1109
US

V. Phone/Fax

Practice location:
  • Phone: 630-998-5994
  • Fax:
Mailing address:
  • Phone: 708-480-2650
  • Fax: 708-575-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: AHMED HASAN ELGAMAL
Title or Position: OWNER
Credential: MD
Phone: 708-480-2650