Provider Demographics
NPI:1235456591
Name:HOUSE CALLS CHICAGO CHARTERED
Entity Type:Organization
Organization Name:HOUSE CALLS CHICAGO CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-699-0293
Mailing Address - Street 1:8539 S SAGINAW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2444
Mailing Address - Country:US
Mailing Address - Phone:708-699-0293
Mailing Address - Fax:
Practice Address - Street 1:8836 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4956
Practice Address - Country:US
Practice Address - Phone:773-629-6036
Practice Address - Fax:773-629-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty