Organization
ADVANCED PHYSICIAN'S ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY E. SMITH MD (DIRECTOR - MEDICAL DIRECTOR)
(773) 374-9292
Entity
Organization
Contact information
Practice address
2315 E 93RD ST, SUITE 440, CHICAGO, IL 60617-3936
(773) 374-9292
(773) 374-4079
Mailing address
2315 E 93RD ST, SUITE 440, CHICAGO, IL 60617-3936
(773) 374-9292
(773) 374-4079
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001617414
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/22/2006
Last updated
08/22/2020
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