Provider Demographics
NPI:1831317411
Name:THE CENTER FOR ADVANCED BREAST CARE S.C.
Entity Type:Organization
Organization Name:THE CENTER FOR ADVANCED BREAST CARE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-797-9000
Mailing Address - Street 1:880 W CENTRAL RD
Mailing Address - Street 2:SUITE 7300
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2355
Mailing Address - Country:US
Mailing Address - Phone:847-797-9000
Mailing Address - Fax:847-797-9099
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 7300
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-797-9000
Practice Address - Fax:847-797-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065367174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210735Medicare ID - Type Unspecified