Provider Demographics
NPI:1760834436
Name:ADVANCED MEDICAL CARE CHICAGO LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CARE CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-429-0571
Mailing Address - Street 1:2751 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2136
Mailing Address - Country:US
Mailing Address - Phone:847-429-0571
Mailing Address - Fax:
Practice Address - Street 1:2751 W 51ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2136
Practice Address - Country:US
Practice Address - Phone:847-429-0571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty