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General NPI Number Information
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NPI Number | 1023801800
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Entity Type | Organization
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Legal Business Name | HOME VISITING DOCTORS MEDICAL GROUP LLC
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 545 WHITE OAK RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2506
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Country | US
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Telephone | 847-407-9676
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Fax | 240-368-1235
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Provider Business Mailing Address
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Address Line | 545 WHITE OAK RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2506
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Country | US
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Telephone | 847-407-9676
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Fax | 240-368-1235
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Authorized Official
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Title or Position | MBR
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Name | GEMMALAINE M SIMBAHAN
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Credential |
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Telephone | 847-407-9676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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