Provider Demographics
NPI:1073632394
Name:AMC MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:AMC MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-223-9494
Mailing Address - Street 1:609 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2420
Mailing Address - Country:US
Mailing Address - Phone:847-223-9494
Mailing Address - Fax:
Practice Address - Street 1:661 GRACELAND AVE
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4518
Practice Address - Country:US
Practice Address - Phone:847-223-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215669Medicare PIN
IL216475Medicare PIN
ILDH0866Medicare PIN