Provider Demographics
NPI:1083007710
Name:ADVANCED PHYSICIANS HOME CARE LLC
Entity type:Organization
Organization Name:ADVANCED PHYSICIANS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHTESHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-914-1414
Mailing Address - Street 1:5 WOOD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1092
Mailing Address - Country:US
Mailing Address - Phone:714-348-8025
Mailing Address - Fax:
Practice Address - Street 1:5 WOOD OAKS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1092
Practice Address - Country:US
Practice Address - Phone:714-348-8025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDOC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
IL36112807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740207505OtherNATIONAL PROVIDER IDENTIFIER