Provider Demographics
NPI:1033214531
Name:WILLOWBROOK FAMILY PRACTICE LTD
Entity Type:Organization
Organization Name:WILLOWBROOK FAMILY PRACTICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-986-1177
Mailing Address - Street 1:6900 S MADISON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:630-986-1177
Mailing Address - Fax:630-986-1198
Practice Address - Street 1:6900 S MADISON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:630-986-1177
Practice Address - Fax:630-986-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL643950Medicare PIN
C42460Medicare UPIN