Provider Demographics
NPI:1184872558
Name:DOCTOR'S ON WHEELS S.C.
Entity type:Organization
Organization Name:DOCTOR'S ON WHEELS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANANDAVALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-464-5986
Mailing Address - Street 1:37 E CHICAGO AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1757
Mailing Address - Country:US
Mailing Address - Phone:815-464-5986
Mailing Address - Fax:815-806-8756
Practice Address - Street 1:37 E CHICAGO AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1757
Practice Address - Country:US
Practice Address - Phone:815-464-5986
Practice Address - Fax:815-806-8756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087425251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087425Medicaid
IL217121OtherPTAN
IL1821083791OtherINDIVIDUAL NPI
IL1184872558OtherNPI
IL1184872558OtherNPI