MEDICARE: ADVANTACARE MULTI-SPECIALTY GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1174982169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTACARE MULTI-SPECIALTY GROUP, LLC

Provider Business Mailing Address
First Line	:	697 MAITLAND AVE
Second Line	:	SUITE 1001
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-6821
Country	:	US
Telephone Number	:	407-539-2111
Fax Number	:	407-539-1211

Provider Business Practice Location Address
First Line	:	815 GOOD HOMES RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6628
Country	:	US
Telephone Number	:	407-601-7940
Fax Number	:	407-704-6943

Authorized Official
Title or Position	:	MEMBER
Name	:	KERRI HERZOG
Credential	:
Telephone Number	:	407-539-2111

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/24/2016

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