Active Therapeutics, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

0384686-5 Issued in IL

Legal business name

ACTIVE THERAPEUTICS, LLC

Practice address

906 Il Route 22
Fox River Grove, IL 60021-1905

Phone

(847) 742-5757

Fax

(847) 428-8615

NPI assigned

Apr 4, 2012

Last updated

Apr 4, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Collura

Title

President

Phone

(847) 829-8708

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333497600000",
    "number": "1831455757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 IL ROUTE 22",
            "city": "FOX RIVER GROVE",
            "state": "IL",
            "postal_code": "600211905",
            "telephone_number": "847-742-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 IL ROUTE 22",
            "city": "FOX RIVER GROVE",
            "state": "IL",
            "postal_code": "600211905",
            "telephone_number": "847-742-5757",
            "fax_number": "847-428-8615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-04",
        "last_updated": "2012-04-04",
        "status": "A",
        "authorized_official_last_name": "COLLURA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-829-8708"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "0384686-5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Fox River Grove, IL
• Providers in Fox River Grove, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.