MEDICARE: ADVANCED PRIMARY CARE, 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	261QC1500X	Community Health Clinic/Center
2	207Q00000X	Family Medicine Physician

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	:	1699958207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PRIMARY CARE, SC

Provider Business Mailing Address
First Line	:	9201 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2102
Country	:	US
Telephone Number	:	847-626-1600
Fax Number	:	847-626-1650

Provider Business Practice Location Address
First Line	:	9201 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2102
Country	:	US
Telephone Number	:	847-626-1600
Fax Number	:	847-626-1650

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE BRODSKY
Credential	:	M.D.
Telephone Number	:	847-626-1600

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	08/30/2021

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