Provider Demographics
NPI:1184031155
Name:HOME VISITING PHYSICIAN GROUP INC
Entity Type:Organization
Organization Name:HOME VISITING PHYSICIAN GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMALUDDIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:AMANULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-267-2034
Mailing Address - Street 1:1021 COURT STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554
Mailing Address - Country:US
Mailing Address - Phone:309-267-2034
Mailing Address - Fax:309-402-0180
Practice Address - Street 1:1021 COURT STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554
Practice Address - Country:US
Practice Address - Phone:309-267-2034
Practice Address - Fax:309-402-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty