Provider Demographics
NPI:1861483570
Name:HOMEWOOD FLOSSMOOR MEDICAL ASSOCIATES SC
Entity Type:Organization
Organization Name:HOMEWOOD FLOSSMOOR MEDICAL ASSOCIATES SC
Other - Org Name:MEDICAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-799-8880
Mailing Address - Street 1:17901 GOVERNORS HIGHWAY
Mailing Address - Street 2:SUITE102
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430
Mailing Address - Country:US
Mailing Address - Phone:708-799-8880
Mailing Address - Fax:708-799-8991
Practice Address - Street 1:17901 GOVERNORS HIGHWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-799-8880
Practice Address - Fax:708-799-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty