Provider Demographics
NPI:1255746715
Name:CENTER FOR ADVANCED MEDICINE LLC
Entity type:Organization
Organization Name:CENTER FOR ADVANCED MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-420-9360
Mailing Address - Street 1:5036 N ILLINOIS ST
Mailing Address - Street 2:STE 1
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3411
Mailing Address - Country:US
Mailing Address - Phone:618-671-6800
Mailing Address - Fax:618-671-6604
Practice Address - Street 1:5036 N ILLINOIS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208
Practice Address - Country:US
Practice Address - Phone:618-671-6800
Practice Address - Fax:619-671-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty