Provider Demographics
NPI:1083721716
Name:ADVANCED MEDICAL ASSOCIATES, SC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLISHCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-763-1334
Mailing Address - Street 1:4711 W GOLF RD
Mailing Address - Street 2:#806
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-763-1334
Mailing Address - Fax:847-763-1737
Practice Address - Street 1:4711 W GOLF RD
Practice Address - Street 2:#806
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-763-1334
Practice Address - Fax:847-763-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty