Basic Information
| Provider Information | |||||||||
| NPI: | 1245694447 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PHYSICIANS GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16101 WEBER RD | ||||||||
| Address2: | |||||||||
| City: | CREST HILL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604038812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153061100 | ||||||||
| FaxNumber: | 8153061105 | ||||||||
| Practice Location | |||||||||
| Address1: | 16101 WEBER RD | ||||||||
| Address2: | |||||||||
| City: | CREST HILL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604038812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153061100 | ||||||||
| FaxNumber: | 8153061105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2016 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | VALLANDIGHAM | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8153061100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.