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General NPI Number Information
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NPI Number | 1528491107
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Entity Type | Organization
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Legal Business Name | HOME BASE MEDICAL, S.C.
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 666 DUNDEE RD SUITE 307
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City | NORTHBROOK
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State | IL
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Zip | 60062-2727
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Country | US
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Telephone | 847-231-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 666 DUNDEE RD SUITE 307
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City | NORTHBROOK
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State | IL
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Zip | 60062-2727
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Country | US
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Telephone | 847-231-2273
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JORDAN DAVID GRUMET
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Credential | MD
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Telephone | 847-942-5214
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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 | IL
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