| Physicians Home Care LLC | |
|
1508 Bloomingdale Rd Ste B Glendale Heights IL 60139-2758 | |
| (331) 871-6674 | |
| (630) 914-8814 |
| Full Name | Physicians Home Care LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1508 Bloomingdale Rd Ste B, Glendale Heights, 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 1508 Bloomingdale Rd Ste B Glendale Heights IL 60139-2758 Ph: (331) 871-6674 | Physicians Home Care LLC 1508 Bloomingdale Rd Ste B Glendale Heights IL 60139-2758 Ph: (331) 871-6674 |
| NPI Number | 1619687175 |
|---|---|
| Provider Enumeration Date | 11/24/2022 |
| Last Update Date | 01/09/2025 |
| Certification Date | 01/09/2025 |
| 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 | () | 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 | Miteshkumar N Modi |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1891829222 PECOS PAC ID: 4385779032 Enrollment ID: I20100319000187 |
| 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 |
| Provider Name | Baongoc Truong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275253866 PECOS PAC ID: 6800266586 Enrollment ID: I20221222000674 |
| Provider Name | Priscilla Marie Lowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710721907 PECOS PAC ID: 2365980174 Enrollment ID: I20240812002075 |
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