Provider Demographics
NPI:1629390885
Name:DIAMOND HOME VISITING PHYSICIANS GROUP,INC
Entity Type:Organization
Organization Name:DIAMOND HOME VISITING PHYSICIANS GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-401-7475
Mailing Address - Street 1:2200 W HIGGINS RD
Mailing Address - Street 2:210
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2428
Mailing Address - Country:US
Mailing Address - Phone:847-401-7475
Mailing Address - Fax:847-885-6065
Practice Address - Street 1:2200 W HIGGINS RD
Practice Address - Street 2:210
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2428
Practice Address - Country:US
Practice Address - Phone:847-401-7475
Practice Address - Fax:847-885-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center