Healthcare Provider Details

I. General information

NPI: 1629266788
Provider Name (Legal Business Name): ADVANCED MEDICAL PRACTICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2007
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

4514 DAVIS ST
SKOKIE IL
60076-1667
US

V. Phone/Fax

Practice location:
  • Phone: 847-897-9010
  • Fax:
Mailing address:
  • Phone: 847-525-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036114127
License Number StateIL

VIII. Authorized Official

Name: DR. ANDREY LEV-WEISSBERG
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 847-525-0421