Provider Demographics
NPI:1396019923
Name:ADVANCED CANCER RESEARCH, LTD
Entity Type:Organization
Organization Name:ADVANCED CANCER RESEARCH, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MACIEJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRAZKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-227-8807
Mailing Address - Street 1:1022 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1831
Mailing Address - Country:US
Mailing Address - Phone:773-227-8807
Mailing Address - Fax:773-227-8907
Practice Address - Street 1:1022 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1831
Practice Address - Country:US
Practice Address - Phone:773-227-8807
Practice Address - Fax:773-227-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083034261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083034OtherIL LICENSE
14977083333OtherNPI # 1