MEDICARE: ADVANCED FAMILY CLINIC LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	036119204	IL

General Provider Information

NPI Number	:	1093977175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED FAMILY CLINIC LTD

Provider Business Mailing Address
First Line	:	2246 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4827
Country	:	US
Telephone Number	:	773-276-6831
Fax Number	:	773-276-9394

Provider Business Practice Location Address
First Line	:	2246 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4827
Country	:	US
Telephone Number	:	773-276-6831
Fax Number	:	773-276-9394

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HALYNA BORYSLAVSKA
Credential	:	MD
Telephone Number	:	773-276-6831

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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