# VINTAGE HOME VISITING PHYSICIANS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073847893
- **Authorized official:** OLIVER AKANO (ADMINISTRATOR)
- **Authorized official phone:** (773) 368-3499

## Contact information

- **Practice address:** 7 BLANCHARD CIR, SUITE 103, WHEATON, IL 60189-2037
- **Practice address phone:** (773) 368-3499
- **Practice address fax:** (630) 260-1035
- **Mailing address:** 7 BLANCHARD CIR, SUITE 103, WHEATON, IL 60189-2037
- **Mailing address phone:** (773) 368-3499
- **Mailing address fax:** (630) 260-1035

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 336055456 | IL | Yes |

## Other

- **Enumeration date:** 09/25/2009
- **Last updated:** 09/25/2009