Provider Demographics
NPI:1023434099
Name:OPTIMAL HOME PHYSICIANS
Entity type:Organization
Organization Name:OPTIMAL HOME PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RULA
Authorized Official - Middle Name:
Authorized Official - Last Name:B
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-340-4355
Mailing Address - Street 1:7321 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1823
Mailing Address - Country:US
Mailing Address - Phone:708-599-0099
Mailing Address - Fax:
Practice Address - Street 1:7321 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1823
Practice Address - Country:US
Practice Address - Phone:708-599-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health