Provider Demographics
NPI:1346822129
Name:HOME DOCTORS MEDICAL PRACTICE PLLC
Entity Type:Organization
Organization Name:HOME DOCTORS MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BONIFACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-910-4229
Mailing Address - Street 1:1901 N ROSELLE RD STE 800
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3186
Mailing Address - Country:US
Mailing Address - Phone:847-908-3471
Mailing Address - Fax:
Practice Address - Street 1:1901 N ROSELLE RD STE 800
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3186
Practice Address - Country:US
Practice Address - Phone:847-908-3471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty