| Physicians Home Care Llc | |
|
2100 Manchester Rd Ste C-1611 Wheaton IL 60187-4579 | |
| (331) 871-6674 | |
| (630) 914-8814 |
| Full Name | Physicians Home Care Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2100 Manchester Rd Ste C-1611, Wheaton, Illinois |
| Authorized Official Name and Position | Maryrose Tamoro Lazatin (OFFICE MANAGER) |
| Authorized Official Contact | 3318716674 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Physicians Home Care Llc 2100 Manchester Rd Ste C-1611 Wheaton IL 60187-4579 Ph: (331) 871-6674 | Physicians Home Care Llc 2100 Manchester Rd Ste C-1611 Wheaton IL 60187-4579 Ph: (331) 871-6674 |
| NPI Number | 1619687175 |
|---|---|
| Provider Enumeration Date | 11/24/2022 |
| Last Update Date | 06/29/2023 |
| Medicare PECOS PAC ID | 9436522968 |
|---|---|
| Medicare Enrollment ID | O20230303002005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619687175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Srinivas Prasad R Jolepalem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568531564 PECOS PAC ID: 6507967510 Enrollment ID: I20070720000464 |
| Provider Name | Ahmed M Memon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033693742 PECOS PAC ID: 2961740832 Enrollment ID: I20190219002452 |
| Provider Name | Oladunni F Boladale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639743107 PECOS PAC ID: 8224436597 Enrollment ID: I20211018002104 |
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