Provider Demographics
NPI:1518235639
Name:ADVANCED ILLINOIS MEDICAL INC
Entity Type:Organization
Organization Name:ADVANCED ILLINOIS MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARRIGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-720-4310
Mailing Address - Street 1:6640 N HARLEM AVE
Mailing Address - Street 2:STE. 1 N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3935
Mailing Address - Country:US
Mailing Address - Phone:847-720-4310
Mailing Address - Fax:
Practice Address - Street 1:2 W TALCOTT RD
Practice Address - Street 2:STE. 32
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5556
Practice Address - Country:US
Practice Address - Phone:847-720-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies