Provider Demographics
NPI:1699109041
Name:ADVANCED PHYSICIAN SERVICES
Entity type:Organization
Organization Name:ADVANCED PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FROHM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-730-9200
Mailing Address - Street 1:888 S ROUTE 59
Mailing Address - Street 2:#140
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0962
Mailing Address - Country:US
Mailing Address - Phone:630-730-9200
Mailing Address - Fax:630-357-9065
Practice Address - Street 1:888 S ROUTE 59
Practice Address - Street 2:#140
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0962
Practice Address - Country:US
Practice Address - Phone:630-730-9200
Practice Address - Fax:630-357-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006364261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty