Provider Demographics
NPI:1790779023
Name:ADVANCED CANCER CLINIC LTD
Entity Type:Organization
Organization Name:ADVANCED CANCER CLINIC LTD
Other - Org Name:MACIEJ DRAZKIEWICZ, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
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 1:2222 W DIVISION ST
Mailing Address - Street 2:#215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-227-8807
Mailing Address - Fax:773-227-8907
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:#215
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
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:2005-09-01
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083034207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083034Medicaid
1497708333OtherNPI ENUMERATOR
IL1275310001Medicare NSC
1497708333OtherNPI ENUMERATOR