Provider Demographics
NPI:1174080337
Name:ADVANCED CARE SPECIALIST GROUP LLC
Entity type:Organization
Organization Name:ADVANCED CARE SPECIALIST GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALZEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-843-3308
Mailing Address - Street 1:5907 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5409
Mailing Address - Country:US
Mailing Address - Phone:708-843-3308
Mailing Address - Fax:
Practice Address - Street 1:5907 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-5409
Practice Address - Country:US
Practice Address - Phone:708-843-3308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty