Organization
VINTAGE HOME VISITING PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLIVER AKANO (ADMINISTRATOR)
(773) 368-3499
Entity
Organization
Contact information
Practice address
7 BLANCHARD CIR, SUITE 103, WHEATON, IL 60189-2037
(773) 368-3499
(630) 260-1035
Mailing address
7 BLANCHARD CIR, SUITE 103, WHEATON, IL 60189-2037
(773) 368-3499
(630) 260-1035
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
336055456
IL
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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