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General NPI Number Information
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NPI Number | 1861483570
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Entity Type | Organization
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Legal Business Name | HOMEWOOD FLOSSMOOR MEDICAL ASSOCIATES SC
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 17901 GOVERNORS HIGHWAY SUITE 102
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City | HOMEWOOD
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State | IL
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Zip | 60430
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Country | US
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Telephone | 708-799-8880
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Fax | 708-799-8991
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Provider Business Mailing Address
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Address Line | 17901 GOVERNORS HIGHWAY SUITE102
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City | HOMEWOOD
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State | IL
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Zip | 60430
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Country | US
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Telephone | 708-799-8880
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Fax | 708-799-8991
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. MICHELLE F FALK
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Credential |
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Telephone | 708-799-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | IL
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