Healthcare Provider Details

I. General information

NPI: 1821445180
Provider Name (Legal Business Name): ACTIVE MEDICAL CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S 8TH ST
WEST DUNDEE IL
60118-2102
US

IV. Provider business mailing address

754 S 8TH ST
WEST DUNDEE IL
60118-2102
US

V. Phone/Fax

Practice location:
  • Phone: 847-836-5202
  • Fax: 847-836-5209
Mailing address:
  • Phone: 847-836-5202
  • Fax: 847-836-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY JOSEPH DARNELL
Title or Position: PRESIDENT
Credential:
Phone: 847-836-5202