Provider Demographics
NPI:1235431628
Name:HOME DOCTORS MANAGEMENT
Entity Type:Organization
Organization Name:HOME DOCTORS MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SRISH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SRIRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-615-2273
Mailing Address - Street 1:611 HUNTER
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-4905
Mailing Address - Country:US
Mailing Address - Phone:847-615-2273
Mailing Address - Fax:877-335-6195
Practice Address - Street 1:611 HUNTER
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-4905
Practice Address - Country:US
Practice Address - Phone:847-615-2273
Practice Address - Fax:877-335-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088401207R00000X, 207RC0000X, 207RC0001X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty