Organization
CENTER FOR ADVANCED MEDICINE LLC
Active
Other names
Performance Medical Clinic LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL THOMAS AMBROSE (OWNER/CEO)
(618) 420-9360
Entity
Organization
Contact information
Practice address
5036 N ILLINOIS ST, SUITE 1, FAIRVIEW HEIGHTS, IL 62208
(618) 671-6800
(619) 671-6604
Mailing address
5036 N ILLINOIS ST, STE 1, FAIRVIEW HEIGHTS, IL 62208-3411
(618) 671-6800
(618) 671-6604
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
06/24/2014
Last updated
07/18/2018
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