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General NPI Number Information
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NPI Number | 1063702991
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Entity Type | Organization
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Legal Business Name | ADVANCED ALTERNATIVE MED CARE
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 9651 W 153RD ST STE, 55
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City | ORLAND PARK
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State | IL
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Zip | 60462-3773
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Country | US
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Telephone | 708-675-1908
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Fax | 708-460-5615
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Provider Business Mailing Address
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Address Line | 9651 W 153RD ST STE. 55
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City | ORLAND PARK
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State | IL
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Zip | 60462-3773
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Country | US
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Telephone | 708-675-1908
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Fax | 708-460-5615
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. JOHN F. OLIVIERI
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Credential | M.D.
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Telephone | 708-473-5994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180001829
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036073886
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License Number State | IL
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