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General NPI Number Information
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NPI Number | 1306217385
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Entity Type | Organization
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Legal Business Name | ADVANCE CHILD CARE LLC
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 2040 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-2128
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Country | US
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Telephone | 773-984-2939
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Fax |
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Provider Business Mailing Address
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Address Line | 5742 N CHRISTIANA AVE APT 1.S
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City | CHICAGO
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State | IL
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Zip | 60659-4594
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Country | US
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Telephone | 773-984-2939
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | NASEERUDDIN GULAM KHAN
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Credential | MD.
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Telephone | 773-984-2939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036126888
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License Number State | IL
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