Provider Demographics
NPI:1417497033
Name:AJ VISITING PHYSICIANS SERVICE CORPORATION
Entity Type:Organization
Organization Name:AJ VISITING PHYSICIANS SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOAQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-670-0819
Mailing Address - Street 1:300 N STATE ST
Mailing Address - Street 2:SUITE 4124
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5414
Mailing Address - Country:US
Mailing Address - Phone:312-670-0819
Mailing Address - Fax:312-670-0829
Practice Address - Street 1:300 N STATE ST
Practice Address - Street 2:SUITE 4124
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3036
Practice Address - Country:US
Practice Address - Phone:312-670-0819
Practice Address - Fax:312-670-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071319207QA0505X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty