MEDICARE: AFFINITY HEALTH CARE 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1205022167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1300 BUSCH PKWY
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4505
Country	:	US
Telephone Number	:	847-459-7860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 BUSCH PKWY
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4505
Country	:	US
Telephone Number	:	847-459-7860
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL C HARTKE
Credential	:
Telephone Number	:	847-342-8220

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	01/07/2008

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