Provider Demographics
NPI:1326101544
Name:ADVANCED CLINIC, LTD.
Entity Type:Organization
Organization Name:ADVANCED CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEQUN
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-717-6860
Mailing Address - Street 1:1600 N RANDALL RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7810
Mailing Address - Country:US
Mailing Address - Phone:847-931-7274
Mailing Address - Fax:847-931-7159
Practice Address - Street 1:1600 N RANDALL ROAD
Practice Address - Street 2:SUITE 135
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7810
Practice Address - Country:US
Practice Address - Phone:847-931-7274
Practice Address - Fax:847-931-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098274207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118999Medicaid
IL036119056Medicaid
IL01635557OtherBLUE CROSS BLUE SHIELD
IL036119056Medicaid