Provider Demographics
NPI:1699710483
Name:HOMA, THEODORE MORRISON (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:MORRISON
Last Name:HOMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:765 ELA RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-6305
Mailing Address - Country:US
Mailing Address - Phone:847-222-9901
Mailing Address - Fax:847-222-9904
Practice Address - Street 1:800 W OAKTON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4602
Practice Address - Country:US
Practice Address - Phone:847-222-9901
Practice Address - Fax:847-222-9904
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-050063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050063OtherLICENSE #
IL110227219OtherRAILROAD MEDICARE
IL036050063OtherLICENSE #
ILC42422Medicare UPIN