Provider Demographics
NPI:1023260023
Name:MEDPRO VISITING PHYSICIANS, LLC
Entity type:Organization
Organization Name:MEDPRO VISITING PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNEL
Authorized Official - Middle Name:VILLAROMAN
Authorized Official - Last Name:MALUNGCOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-727-2751
Mailing Address - Street 1:1571 WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-3273
Mailing Address - Country:US
Mailing Address - Phone:773-727-2751
Mailing Address - Fax:630-226-5390
Practice Address - Street 1:7518 TRIPP AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3812
Practice Address - Country:US
Practice Address - Phone:773-727-2751
Practice Address - Fax:630-226-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty