MEDICARE: ILLINOIS HOME MED VISITS

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	208D00000X	General Practice Physician	036070414	IL

General Provider Information

NPI Number	:	1770886061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS HOME MED VISITS

Provider Business Mailing Address
First Line	:	7257 W TOUHY AVE
Second Line	:	SUITE 201A
City	:	CHICAGO
State	:	IL
Zip	:	60631-4342
Country	:	US
Telephone Number	:	773-631-6000
Fax Number	:	773-894-7772

Provider Business Practice Location Address
First Line	:	820 E OLD WILLOW RD
Second Line	:	UNIT #112
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-2152
Country	:	US
Telephone Number	:	773-631-6000
Fax Number	:	773-894-7772

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROLANDO SALVATIERRA SAJOR
Credential	:	MD
Telephone Number	:	773-631-6000

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	06/20/2011

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Directions to “ILLINOIS HOME MED VISITS ” Practice Location

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