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General NPI Number Information
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NPI Number | 1184031155
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Entity Type | Organization
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Legal Business Name | HOME VISITING PHYSICIAN GROUP INC
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 1021 COURT STREET SUITE B
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City | PEKIN
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State | IL
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Zip | 61554
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Country | US
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Telephone | 309-267-2034
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Fax | 309-402-0180
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Provider Business Mailing Address
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Address Line | 1021 COURT STREET SUITE B
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City | PEKIN
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State | IL
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Zip | 61554
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Country | US
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Telephone | 309-267-2034
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Fax | 309-402-0180
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JAMALUDDIN F AMANULLAH
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Credential | MD
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Telephone | 309-267-2034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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