Provider Demographics
NPI:1518153600
Name:VISITING DOCTORS NETWORK LLC
Entity Type:Organization
Organization Name:VISITING DOCTORS NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNALYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HIBOGAMBOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-980-8410
Mailing Address - Street 1:1 TIFFANY PT
Mailing Address - Street 2:SUITE G-18
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2936
Mailing Address - Country:US
Mailing Address - Phone:630-980-8140
Mailing Address - Fax:630-980-8148
Practice Address - Street 1:1 TIFFANY PT
Practice Address - Street 2:SUITE G-18
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2936
Practice Address - Country:US
Practice Address - Phone:630-980-8140
Practice Address - Fax:630-980-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215763Medicare PIN