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General NPI Number Information
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NPI Number | 1811998438
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Entity Type | Organization
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Legal Business Name | HOME PHYSICIANS PC
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 1340 S DAMEN AVE SUITE 210
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City | CHICAGO
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State | IL
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Zip | 60608-1169
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Country | US
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Telephone | 773-292-4800
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Fax | 773-384-7053
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Provider Business Mailing Address
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Address Line | 1340 S DAMEN AVE STE 400
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City | CHICAGO
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State | IL
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Zip | 60608-1169
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Country | US
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Telephone | 773-292-4800
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Fax | 773-384-7053
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | MICHAEL FESSENDEN
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Credential |
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Telephone | 615-401-4634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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