MEDICARE: ADVANCE MIDWEST MEDICAL SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036111523	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659512804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE MIDWEST MEDICAL SC

Provider Business Mailing Address
First Line	:	319 S BARRINGTON RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-5345
Country	:	US
Telephone Number	:	312-953-0949
Fax Number	:	847-241-4467

Provider Business Practice Location Address
First Line	:	319 S BARRINGTON RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-5345
Country	:	US
Telephone Number	:	312-953-0949
Fax Number	:	847-241-4467

Authorized Official
Title or Position	:	OWNER / PHYSICIAN
Name	:	RAJIV SOOD
Credential	:	M.D.
Telephone Number	:	312-953-0949

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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