Organization Name: | ADVANCED HEALTHCARE PROVIDERS, SC |
NPI Number: | 1770839698 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT A DYER (PRESIDENT) |
Mailing Address: | 860 Biester Dr Suite 103 Belvidere |
State: | IL US |
Postal Code: | 610084053 |
Phone Number: | 8155443894 |
Fax Number: | |
NPI Enumeration Date: | 07/29/2012 |
NPI Last Update Date: | 07/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 36078826 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |