Provider Demographics
NPI:1912918699
Name:HOME MD LLC.
Entity type:Organization
Organization Name:HOME MD LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:DADIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-772-8770
Mailing Address - Street 1:3426 W ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3720
Mailing Address - Country:US
Mailing Address - Phone:773-772-8770
Mailing Address - Fax:847-307-8314
Practice Address - Street 1:3426 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3720
Practice Address - Country:US
Practice Address - Phone:773-772-8770
Practice Address - Fax:847-307-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212967Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION N