Provider Demographics
NPI:1659394914
Name:ADVANCED PHYSICAL MEDICINE & REHABILITATION LTD
Entity type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE & REHABILITATION LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-839-8888
Mailing Address - Street 1:2500 W HIGGINS RD STE 310
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7214
Mailing Address - Country:US
Mailing Address - Phone:847-839-8888
Mailing Address - Fax:847-839-9660
Practice Address - Street 1:2500 W HIGGINS RD STE 310
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7214
Practice Address - Country:US
Practice Address - Phone:847-839-8888
Practice Address - Fax:847-839-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
IL042-617395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202183Medicare PIN
IL706410Medicare PIN