MEDICARE: VISITING PHYSICIANS HOME CARE 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1811496979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISITING PHYSICIANS HOME CARE S.C.

Provider Business Mailing Address
First Line	:	3030 CHICAGO RD
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1055
Country	:	US
Telephone Number	:	708-300-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 CHICAGO RD
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1055
Country	:	US
Telephone Number	:	708-300-6692
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KHAJA ASADULLAH
Credential	:	MD
Telephone Number	:	708-300-6692

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	02/05/2018

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