Provider Demographics
NPI:1386804763
Name:ADVANCED CENTER FOR INTERNAL MEDICINE, S.C.
Entity type:Organization
Organization Name:ADVANCED CENTER FOR INTERNAL MEDICINE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRALI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-262-0888
Mailing Address - Street 1:302 RANDALL RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4209
Mailing Address - Country:US
Mailing Address - Phone:630-262-0888
Mailing Address - Fax:630-262-0999
Practice Address - Street 1:2172 BLACKBERRY DR STE 101
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1103
Practice Address - Country:US
Practice Address - Phone:630-262-0888
Practice Address - Fax:630-262-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K51623Medicare UPIN
216694Medicare PIN