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General NPI Number Information
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NPI Number | 1275914079
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Entity Type | Organization
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Legal Business Name | INHOUSE PHYSICIANS, S.C.
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 05/17/2019
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Provider Practice Location Address
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Address Line | 410 N MAIN ST
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City | MIDDLEBURY
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State | IN
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Zip | 46540-9216
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Country | US
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Telephone | 630-730-0364
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Fax | 630-524-9182
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Provider Business Mailing Address
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Address Line | 1560 WALL ST STE 335
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City | NAPERVILLE
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State | IL
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Zip | 60563-1267
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Country | US
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Telephone | 630-634-7307
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Fax | 630-524-9182
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Authorized Official
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Title or Position | CEO
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Name | DR. JONATHAN GLENN SPERO
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Credential | M.D.
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Telephone | 630-584-2235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036.108385
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License Number State | IL
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