Provider Demographics
NPI:1184789968
Name:ADVANCED PHYSICIAN'S ASSOCIATION
Entity type:Organization
Organization Name:ADVANCED PHYSICIAN'S ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-374-9292
Mailing Address - Street 1:2315 E 93RD ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3936
Mailing Address - Country:US
Mailing Address - Phone:773-374-9292
Mailing Address - Fax:773-374-4079
Practice Address - Street 1:2315 E 93RD ST
Practice Address - Street 2:SUITE 440
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3936
Practice Address - Country:US
Practice Address - Phone:773-374-9292
Practice Address - Fax:773-374-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001617414OtherBLUE CROSS BLUE SHIELD