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General NPI Number Information
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NPI Number | 1336225317
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Entity Type | Organization
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Legal Business Name | ADVANTAGE MEDICAL GROUP S.C.
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12770 S HARLEM AVE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-2145
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Country | US
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Telephone | 708-923-0636
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Fax | 708-923-0669
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Provider Business Mailing Address
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Address Line | 12770 S. HARLEM AVENUE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-2145
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Country | US
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Telephone | 708-923-0636
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Fax | 708-923-0669
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN HAUSER
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Credential | D.C.
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Telephone | 708-923-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State | IL
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