Healthcare Provider Details

I. General information

NPI: 1972959054
Provider Name (Legal Business Name): ADVOCATE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9831 S WESTERN AVE SUITE 396
CHICAGO IL
60643-1740
US

IV. Provider business mailing address

9831 S WESTERN AVE SUITE 396
CHICAGO IL
60643-1740
US

V. Phone/Fax

Practice location:
  • Phone: 773-881-5632
  • Fax:
Mailing address:
  • Phone: 773-881-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number051294363
License Number StateIL

VIII. Authorized Official

Name: DR. ADWOA BOATEMA DARKWA
Title or Position: CLINICAL PHARMACIST
Credential: PHARMD
Phone: 773-881-5632