Healthcare Provider Details

I. General information

NPI: 1124075288
Provider Name (Legal Business Name): ADVANCED PHYSICIANS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/08/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 WEBER RD
CREST HILL IL
60403-8812
US

IV. Provider business mailing address

16101 WEBER RD
CREST HILL IL
60403-8812
US

V. Phone/Fax

Practice location:
  • Phone: 815-836-3799
  • Fax: 815-836-8799
Mailing address:
  • Phone: 815-836-3799
  • Fax: 815-836-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANA M VALLANDIGHAM
Title or Position: PRESIDENT
Credential: DC
Phone: 815-306-1100