Basic Information
| Provider Information | |||||||||
| NPI: | 1124075288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PHYSICIANS, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6300 KINGERY HWY | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | WILLOW BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605272248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307893338 | ||||||||
| FaxNumber: | 6307893394 | ||||||||
| Practice Location | |||||||||
| Address1: | 6300 KINGERY HWY | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | WILLOW BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605272248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307893338 | ||||||||
| FaxNumber: | 6307893394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VALLANDIGHAM | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6307893338 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P2900X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.