Basic Information
| Provider Information | |||||||||
| NPI: | 1861729493 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN HOME VISITS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13928 BAINWICK DRIVE NW | ||||||||
| Address2: | |||||||||
| City: | PICKINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409190234 | ||||||||
| FaxNumber: | 6142993406 | ||||||||
| Practice Location | |||||||||
| Address1: | 13928 BAINWICK DRIVE NW | ||||||||
| Address2: | |||||||||
| City: | PICKINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409190234 | ||||||||
| FaxNumber: | 6142993406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 11/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | AWAN | ||||||||
| AuthorizedOfficialFirstName: | ZAFAR | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6142971158 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35088573 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 35088573 | 01 | OH | MEDICAL LICENSE | OTHER |