MEDICARE: AXIOM MEDICAL CLINIC 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	207Q00000X	Family Medicine Physician	ME 93347	FL
2	111N00000X	Chiropractor	CH 8788	FL
3	225100000X	Physical Therapist	PT20245	FL

General Provider Information

NPI Number	:	1750335329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIOM MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	7177 CRIMSON RIDGE DR
Second Line	:	SUITE 14
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6208
Country	:	US
Telephone Number	:	815-227-9900
Fax Number	:	815-227-9805

Provider Business Practice Location Address
First Line	:	9507 ANDERSON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1252
Country	:	US
Telephone Number	:	813-319-1330
Fax Number	:	813-319-1340

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	WENDY NEWMAN
Credential	:
Telephone Number	:	815-227-9900

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	09/11/2025

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Directions to “AXIOM MEDICAL CLINIC LLC ” Practice Location

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