Provider Demographics
NPI:1831996115
Name:ADVANCED CARE CENTER PLLC
Entity type:Organization
Organization Name:ADVANCED CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:MGR
Authorized Official - Phone:419-376-5856
Mailing Address - Street 1:1340 S COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3010
Mailing Address - Country:US
Mailing Address - Phone:248-438-6600
Mailing Address - Fax:248-313-9210
Practice Address - Street 1:1340 S COMMERCE RD
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3010
Practice Address - Country:US
Practice Address - Phone:248-438-6600
Practice Address - Fax:248-313-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty