Provider Demographics
NPI:1376804864
Name:PHYSICIAN SERVICES AT HOME S.C
Entity Type:Organization
Organization Name:PHYSICIAN SERVICES AT HOME S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:F
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-590-3221
Mailing Address - Street 1:900 JORIE BLVD
Mailing Address - Street 2:SUITE # 58C
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2213
Mailing Address - Country:US
Mailing Address - Phone:630-590-3221
Mailing Address - Fax:630-599-1350
Practice Address - Street 1:900 JORIE BLVD
Practice Address - Street 2:SUITE # 58C
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2213
Practice Address - Country:US
Practice Address - Phone:630-590-3221
Practice Address - Fax:630-599-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty