Provider Demographics
NPI:1063585511
Name:ADVANCED MEDICAL AND REHABILITATION LTD
Entity type:Organization
Organization Name:ADVANCED MEDICAL AND REHABILITATION LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUREVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-897-5995
Mailing Address - Street 1:150 W HALF DAY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6591
Mailing Address - Country:US
Mailing Address - Phone:847-821-1070
Mailing Address - Fax:847-821-1126
Practice Address - Street 1:150 W HALF DAY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6591
Practice Address - Country:US
Practice Address - Phone:847-897-5995
Practice Address - Fax:847-897-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104844208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDE1545OtherRR MC
ILP00080504OtherRR MC
ILDD7475OtherRR MC
IL036104844Medicaid
IL211963Medicare PIN
ILDD7475OtherRR MC
ILDE1545OtherRR MC