Provider Demographics
NPI:1154069904
Name:AT HOME MEDICAL PRACTITIONERS LLC
Entity Type:Organization
Organization Name:AT HOME MEDICAL PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANIER
Authorized Official - Middle Name:
Authorized Official - Last Name:GULOY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:773-971-9643
Mailing Address - Street 1:139 MILLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2936
Mailing Address - Country:US
Mailing Address - Phone:224-628-6981
Mailing Address - Fax:
Practice Address - Street 1:139 MILLBROOK LN
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2936
Practice Address - Country:US
Practice Address - Phone:224-628-6981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty