Provider Demographics
NPI:1487663241
Name:ADVANCED PHYSICAL MEDICINE ASSOCIATES SC
Entity type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PREISDENT OF APMA SA
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SARANTOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-924-1450
Mailing Address - Street 1:490 WEST LAKE STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3500
Mailing Address - Country:US
Mailing Address - Phone:630-924-1450
Mailing Address - Fax:630-924-1459
Practice Address - Street 1:490 WEST LAKE STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3500
Practice Address - Country:US
Practice Address - Phone:630-924-1450
Practice Address - Fax:630-924-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094371208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6206500001OtherMEDICARE DME NUMBER
IL6206500001Medicare NSC
G38160Medicare UPIN
IL208596Medicare ID - Type Unspecified
IL208593Medicare ID - Type Unspecified
IL6206500001Medicare PIN