Provider Demographics
NPI:1023801800
Name:HOME VISITING DOCTORS MEDICAL GROUP LLC
Entity type:Organization
Organization Name:HOME VISITING DOCTORS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:GEMMALAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMBAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-407-9676
Mailing Address - Street 1:545 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2506
Mailing Address - Country:US
Mailing Address - Phone:847-407-9676
Mailing Address - Fax:240-368-1235
Practice Address - Street 1:545 WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2506
Practice Address - Country:US
Practice Address - Phone:847-407-9676
Practice Address - Fax:240-368-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-26
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care