Provider Demographics
NPI:1275914079
Name:INHOUSE PHYSICIANS, S.C.
Entity Type:Organization
Organization Name:INHOUSE PHYSICIANS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:SPERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-584-2235
Mailing Address - Street 1:1560 WALL ST STE 335
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1267
Mailing Address - Country:US
Mailing Address - Phone:630-634-7307
Mailing Address - Fax:630-524-9182
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9216
Practice Address - Country:US
Practice Address - Phone:630-730-0364
Practice Address - Fax:630-524-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.108385208D00000X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1184693111Medicare UPIN