MEDICARE: HOUSECALL PHYSICIANS OF ILLINOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209.010054	IL

General Provider Information

NPI Number	:	1144568072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSECALL PHYSICIANS OF ILLINOIS

Provider Business Mailing Address
First Line	:	1100 W CERMAK RD
Second Line	:	SUITE C-500
City	:	CHICAGO
State	:	IL
Zip	:	60608-4500
Country	:	US
Telephone Number	:	312-243-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 W CERMAK RD
Second Line	:	SUITE C-500
City	:	CHICAGO
State	:	IL
Zip	:	60608-4500
Country	:	US
Telephone Number	:	312-243-2223
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANA ROBINSON
Credential	:
Telephone Number	:	312-243-2223

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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