MEDICARE: INHOUSE PHYSICIANS, S.C.

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	261QH0100X	Health Service Clinic/Center
2	208D00000X	General Practice Physician	036.108385	IL

General Provider Information

NPI Number	:	1275914079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INHOUSE PHYSICIANS, S.C.

Provider Business Mailing Address
First Line	:	1560 WALL ST STE 335
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-1267
Country	:	US
Telephone Number	:	630-634-7307
Fax Number	:	630-524-9182

Provider Business Practice Location Address
First Line	:	410 N MAIN ST
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-9216
Country	:	US
Telephone Number	:	630-730-0364
Fax Number	:	630-524-9182

Authorized Official
Title or Position	:	CEO
Name	:	DR. JONATHAN GLENN SPERO
Credential	:	M.D.
Telephone Number	:	630-584-2235

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	05/17/2019

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Directions to “INHOUSE PHYSICIANS, S.C. ” Practice Location

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