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General NPI Number Information
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NPI Number | 1346914074
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Entity Type | Organization
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Legal Business Name | ADVANCE CARE MEDICAL PCP ILLINOIS
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 2975 SHOWPLACE DR
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City | NAPERVILLE
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State | IL
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Zip | 60564-5004
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Country | US
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Telephone | 516-801-1552
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SCHOOL ST
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City | GLEN COVE
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State | NY
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Zip | 11542-2590
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Country | US
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Telephone | 516-801-1552
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Fax |
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Authorized Official
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Title or Position | SENIOR ADVISOR
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Name | DOUGLAS MILLAR
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Credential |
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Telephone | 917-673-6321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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