Provider Demographics
NPI:1306873674
Name:GARRETSON, HOMA & KIM, MD SC
Entity type:Organization
Organization Name:GARRETSON, HOMA & KIM, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-222-9901
Mailing Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1565
Mailing Address - Country:US
Mailing Address - Phone:847-222-9901
Mailing Address - Fax:847-222-9904
Practice Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1565
Practice Address - Country:US
Practice Address - Phone:847-222-9901
Practice Address - Fax:847-222-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL952580Medicare PIN