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General NPI Number Information
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NPI Number | 1598019051
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Entity Type | Organization
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Legal Business Name | ADVOCATE MEDICAL GROUP
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 3040 N WILTON AVE 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-4424
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Country | US
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Telephone | 773-296-5603
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 N WILTON AVE 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-4424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COORDINATOR, MANAGER
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Name | DR. LORI OSBORNE
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Credential | PH.D.
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Telephone | 773-296-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283XC2000X
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Taxonomy Name | Children's Rehabilitation Hospital
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License Number | 071008251
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License Number State | IL
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