MEDICARE: ADVANCED HEALTH MEDICAL SC

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	208D00000X	General Practice Physician	036127178	IL

General Provider Information

NPI Number	:	1720461338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEALTH MEDICAL SC

Provider Business Mailing Address
First Line	:	1147 S WABASH AVE
Second Line	:	SUITE 250
City	:	CHICAGO
State	:	IL
Zip	:	60605-2346
Country	:	US
Telephone Number	:	312-987-4878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1147 S WABASH AVE
Second Line	:	SUITE 250
City	:	CHICAGO
State	:	IL
Zip	:	60605-2346
Country	:	US
Telephone Number	:	312-987-4878
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JAQUELYN BITLER
Credential	:
Telephone Number	:	614-395-9132

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/30/2015

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Directions to “ADVANCED HEALTH MEDICAL SC ” Practice Location

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