Organization
ADVANCED CLINIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS LEQUN CAO M.D. (PRESIDENT)
(847) 717-6860
Entity
Organization
Contact information
Practice address
1600 N RANDALL ROAD, SUITE 135, ELGIN, IL 60123-7810
(847) 931-7274
(847) 931-7159
Mailing address
1600 N RANDALL RD, SUITE 135, ELGIN, IL 60123-7810
(847) 931-7274
(847) 931-7159
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036098274
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635557
BLUE CROSS BLUE SHIELD
IL
05
—
036118999
—
IL
05
—
036119056
—
IL
Enumeration date
12/18/2006
Last updated
01/22/2014
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