Healthcare Provider Details

I. General information

NPI: 1275914079
Provider Name (Legal Business Name): INHOUSE PHYSICIANS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N MAIN ST
MIDDLEBURY IN
46540-9216
US

IV. Provider business mailing address

1560 WALL ST STE 335
NAPERVILLE IL
60563-1267
US

V. Phone/Fax

Practice location:
  • Phone: 630-730-0364
  • Fax: 630-524-9182
Mailing address:
  • Phone: 630-634-7307
  • Fax: 630-524-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.108385
License Number StateIL

VIII. Authorized Official

Name: DR. JONATHAN GLENN SPERO
Title or Position: CEO
Credential: M.D.
Phone: 630-584-2235