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General NPI Number Information
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NPI Number | 1023253630
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Entity Type | Organization
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Legal Business Name | YOUR HOME PHYSICIANS, INC.
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 6405 N CAMPBELL AVE
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City | CHICAGO
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State | IL
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Zip | 60645-5313
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Country | US
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Telephone | 773-465-0003
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Fax | 773-465-0004
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Provider Business Mailing Address
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Address Line | 6405 N CAMPBELL AVE
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City | CHICAGO
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State | IL
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Zip | 60645-5313
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Country | US
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Telephone | 773-465-0003
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Fax | 773-465-0004
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Authorized Official
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Title or Position | PRESIDENT
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Name | REGINA M MAHMOOD
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Credential | ADV. PRACTICE NURSE
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Telephone | 773-465-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 263296680
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209006095
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License Number State | IL
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