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General NPI Number Information
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NPI Number | 1982879573
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICIANS NETWORK, INC.
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 326 W 64TH ST SUITE 301
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City | CHICAGO
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State | IL
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Zip | 60621-3114
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Country | US
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Telephone | 773-317-0905
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Fax | 773-874-7701
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Provider Business Mailing Address
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Address Line | 326 W 64TH ST SUITE 301
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City | CHICAGO
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State | IL
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Zip | 60621-3114
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Country | US
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Telephone | 773-317-0905
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Fax | 773-874-7701
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | DR. LEOPOLCO L JURADO
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Credential | M.D.
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Telephone | 773-874-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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