| Organization Name: | MEDPRO VISITING PHYSICIANS, LLC |
| NPI Number: | 1023260023 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ARNEL VILLAROMAN MALUNGCOT (ADMINISTRATOR) |
| Mailing Address: | 7518 Tripp Ave Skokie |
| State: | IL US |
| Postal Code: | 600763812 |
| Phone Number: | 7737272751 |
| Fax Number: | 6302265390 |
| NPI Enumeration Date: | 10/21/2008 |
| NPI Last Update Date: | 10/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |