Provider Demographics
NPI:1144644592
Name:VISITING PHYSICIAN AT HOME LLC
Entity type:Organization
Organization Name:VISITING PHYSICIAN AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUKHWINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-917-3664
Mailing Address - Street 1:2119 BEAVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3812
Mailing Address - Country:US
Mailing Address - Phone:847-917-3664
Mailing Address - Fax:225-538-3038
Practice Address - Street 1:2970 MARIA AVE
Practice Address - Street 2:SUITE 102A
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2017
Practice Address - Country:US
Practice Address - Phone:847-917-3664
Practice Address - Fax:224-538-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization