| Zigma Visiting Physician, Llc | |
|
4 N Deer Point Dr 1002 Hainesville IL 60030 | |
| (847) 946-0198 | |
| (847) 972-6265 |
| Full Name | Zigma Visiting Physician, Llc |
|---|---|
| Speciality | General Practice |
| Location | 4 N Deer Point Dr, Hainesville, Illinois |
| Authorized Official Name and Position | Evillo M Domingo (PRESIDENT) |
| Authorized Official Contact | 5672246045 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Zigma Visiting Physician, Llc 4 N Deer Point Dr 1002 Hainesville IL 60030-3814 Ph: (847) 946-0198 | Zigma Visiting Physician, Llc 4 N Deer Point Dr 1002 Hainesville IL 60030 Ph: (847) 946-0198 |
| NPI Number | 1093175804 |
|---|---|
| Provider Enumeration Date | 03/07/2016 |
| Last Update Date | 09/26/2019 |
| Medicare PECOS PAC ID | 0547566994 |
|---|---|
| Medicare Enrollment ID | O20160310000631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093175804 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Theodore M Homa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699710483 PECOS PAC ID: 5597810796 Enrollment ID: I20090921000393 |
| Provider Name | Naomi Lockett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235536350 PECOS PAC ID: 1951626266 Enrollment ID: I20150209001171 |
| Provider Name | Jillian Radecki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952018368 PECOS PAC ID: 1052783446 Enrollment ID: I20230213001267 |
| Provider Name | Jamie Cadet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538844626 PECOS PAC ID: 4587024898 Enrollment ID: I20230718004035 |
| Provider Name | Dean Michael Villon Gorospe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265117204 PECOS PAC ID: 1759742943 Enrollment ID: I20230803004107 |
| Provider Name | Jeenu James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235982893 PECOS PAC ID: 6800236126 Enrollment ID: I20240502002603 |
| Provider Name | Sherin Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730931106 PECOS PAC ID: 1951742626 Enrollment ID: I20240513000782 |
| Provider Name | Indu Abraham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538913942 PECOS PAC ID: 2769823970 Enrollment ID: I20240517002661 |