Provider Demographics
NPI:1194026203
Name:ADVANCED INTERNAL MEDICINE ASSOCIATES INC
Entity Type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPESHKUMAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-909-0177
Mailing Address - Street 1:726 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2352
Mailing Address - Country:US
Mailing Address - Phone:847-909-0177
Mailing Address - Fax:
Practice Address - Street 1:1500 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5340
Practice Address - Country:US
Practice Address - Phone:847-498-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI036.121329261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI170484Medicare UPIN