Provider Demographics
NPI:1952678625
Name:ANGELA HARPER MAHOME, M.D., S.C.
Entity Type:Organization
Organization Name:ANGELA HARPER MAHOME, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-521-1889
Mailing Address - Street 1:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-0613
Mailing Address - Country:US
Mailing Address - Phone:815-521-1889
Mailing Address - Fax:815-521-1889
Practice Address - Street 1:15127 S 73RD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4398
Practice Address - Country:US
Practice Address - Phone:815-521-1889
Practice Address - Fax:815-521-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-24
Last Update Date:2011-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361080082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty