Organization
MIDAMERICA HOME PHYSICIANS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EMMANUEL JAMBARO GUERRERO (PRESIDENT)
(773) 842-0373
Entity
Organization
Contact information
Practice address
2244 W. FULLERTON AVE., CHICAGO, IL 60618
(773) 842-0373
Mailing address
2244 W. FULLERTON AVE., CHICAGO, IL 60618
(773) 842-0373
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
041201839
IL
Other
Enumeration date
04/24/2015
Last updated
04/24/2015
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