Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Theodise Harris, FNP-BC

Individual provider Family Nurse Practitioner · NPI 1134716830

Mr. Theodise Harris, FNP-BC is a Nurse Practitioner in Chicago, Illinois. Qualified in 2019, 7 years ago. Practices with MD @ Home Illinois, SC, a 53-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
7
Licensed in
IL
In the registry since
2020
What do these letters mean?
FNP-BC — Family Nurse Practitioner, Board Certified
A family nurse practitioner certified by the ANCC.

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Practice location Address checks out

2003 W Fulton St
Chicago, IL 60612-2345
Phone: (312) 243-2223
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 209022572 (IL)

Record details

NPI number1134716830
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-BC
Sole proprietorYes
NPI enumeratedDecember 29, 2020
Last updated in NPPESMarch 28, 2022
Certification dateApril 21, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Md @ Home Illinois, Sc — 53 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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