MEDICARE: IN HOME DIAGNOSTICS, LLC

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	246XC2903X	Vascular Specialist/Technologist Cardiovascular

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1841218740	OTHER	IL	NPI

General Provider Information

NPI Number	:	1841218740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	3319 N. ELSTON AVE.
Second Line	:	SUITE 116
City	:	CHICAGO
State	:	IL
Zip	:	60618-5811
Country	:	US
Telephone Number	:	773-751-7325
Fax Number	:	773-583-4401

Provider Business Practice Location Address
First Line	:	3319 N. ELSTON AVE.
Second Line	:	SUITE 116
City	:	CHICAGO
State	:	IL
Zip	:	60618-5811
Country	:	US
Telephone Number	:	773-751-7325
Fax Number	:	773-583-4401

Authorized Official
Title or Position	:	CEO
Name	:	DAVID EVANS
Credential	:
Telephone Number	:	773-751-7325

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	09/17/2012

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Directions to “IN HOME DIAGNOSTICS, LLC ” Practice Location

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