MEDICARE: ADVANCED CANCER CLINIC LTD

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	207RH0003X	Hematology & Oncology Physician	036083034	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
2	1497708333	OTHER		NPI ENUMERATOR

General Provider Information

NPI Number	:	1790779023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CANCER CLINIC LTD

Provider Business Mailing Address
First Line	:	2222 W DIVISION ST
Second Line	:	#215
City	:	CHICAGO
State	:	IL
Zip	:	60622-2717
Country	:	US
Telephone Number	:	773-227-8807
Fax Number	:	773-227-8907

Provider Business Practice Location Address
First Line	:	2222 W DIVISION ST
Second Line	:	#215
City	:	CHICAGO
State	:	IL
Zip	:	60622-2717
Country	:	US
Telephone Number	:	773-227-8807
Fax Number	:	773-227-8907

Authorized Official
Title or Position	:	DIRECTOR/PRESIDENT
Name	:	DR. MACIEJ K DRAZKIEWICZ
Credential	:	MD
Telephone Number	:	773-227-8807

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	04/23/2013

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Directions to “ADVANCED CANCER CLINIC LTD ” Practice Location

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