Provider Demographics
NPI:1912347311
Name:HOME PHYSICIAN CARE LLC
Entity Type:Organization
Organization Name:HOME PHYSICIAN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-578-6385
Mailing Address - Street 1:7870 LINCOLN AVE STE 103B
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 E US ROUTE 6
Practice Address - Street 2:SUITE A
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-9042
Practice Address - Country:US
Practice Address - Phone:224-578-6385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty