Provider Demographics
NPI:1235925587
Name:ADVANCED FAMILY MEDICINE, PLLC
Entity type:Organization
Organization Name:ADVANCED FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-712-4381
Mailing Address - Street 1:5201 WILLOW SPRINGS RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6506
Mailing Address - Country:US
Mailing Address - Phone:708-929-6099
Mailing Address - Fax:708-929-6169
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 180
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6506
Practice Address - Country:US
Practice Address - Phone:708-929-6099
Practice Address - Fax:708-929-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty