Provider Demographics
NPI:1972959054
Name:ADVOCATE MEDICAL GROUP
Entity type:Organization
Organization Name:ADVOCATE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADWOA
Authorized Official - Middle Name:BOATEMA
Authorized Official - Last Name:DARKWA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:773-881-5632
Mailing Address - Street 1:9831 S WESTERN AVE
Mailing Address - Street 2:SUITE 396
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1740
Mailing Address - Country:US
Mailing Address - Phone:773-881-5632
Mailing Address - Fax:
Practice Address - Street 1:9831 S WESTERN AVE
Practice Address - Street 2:SUITE 396
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1740
Practice Address - Country:US
Practice Address - Phone:773-881-5632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294363261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care