Provider Demographics
NPI:1417180431
Name:CHICAGOLAND HOME BIRTH
Entity type:Organization
Organization Name:CHICAGOLAND HOME BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-895-3311
Mailing Address - Street 1:6648 N FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4406
Mailing Address - Country:US
Mailing Address - Phone:773-895-3311
Mailing Address - Fax:866-272-8433
Practice Address - Street 1:6648 N FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4406
Practice Address - Country:US
Practice Address - Phone:773-895-3311
Practice Address - Fax:866-272-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty