NPI 1336267855

Mdm Advanced Ancillary Services, LLC

Organisation Exclusive Provider Organization Mokena, IL

Practice location

Address: 19065 Hickory Creek Pl Suite 240, Mokena, IL 60448-8507
Phone: (708) 478-6417
Fax: (708) 535-8087
Mailing address: Dept 10116 PO Box 87618, Chicago, IL 60680-0618

Authorised official

Name: Jon Knipper
Title: Chief Operating Officer
Phone: (708) 478-6434

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1336267855
Entity type: Organization
NPI issued: 26 Mar 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.