Healthcare Provider Details

I. General information

NPI: 1407588031
Provider Name (Legal Business Name): ADVANCED ADDICTION CONSULTANTS CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 110
PARK RIDGE IL
60068-1125
US

IV. Provider business mailing address

541 HELEN DR
NORTHBROOK IL
60062-2527
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREY LEV-WEISSBERG
Title or Position: OWNER
Credential: MD
Phone: 847-897-9010