Provider Demographics
NPI:1134364318
Name:ADVOCATE CHRIST FAMILY MEDICINE CENTER
Entity type:Organization
Organization Name:ADVOCATE CHRIST FAMILY MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-5700
Mailing Address - Street 1:4140 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:HOMETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:60456-1135
Mailing Address - Country:US
Mailing Address - Phone:708-422-5700
Mailing Address - Fax:
Practice Address - Street 1:4140 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:HOMETOWN
Practice Address - State:IL
Practice Address - Zip Code:60456-1135
Practice Address - Country:US
Practice Address - Phone:708-422-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053019261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care