MEDICARE: ADVENT MEDICAL CORP

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	208600000X	Surgery Physician	036056166	IL

General Provider Information

NPI Number	:	1316014384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENT MEDICAL CORP

Provider Business Mailing Address
First Line	:	4800 S CHICAGO BEACH DR
Second Line	:	901-N
City	:	CHICAGO
State	:	IL
Zip	:	60615-7032
Country	:	US
Telephone Number	:	773-230-6202
Fax Number	:	773-289-0888

Provider Business Practice Location Address
First Line	:	4800 S CHICAGO BEACH DR
Second Line	:	901-N
City	:	CHICAGO
State	:	IL
Zip	:	60615-7032
Country	:	US
Telephone Number	:	773-230-6202
Fax Number	:	773-289-0888

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARY BAHL
Credential	:
Telephone Number	:	773-230-6202

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	09/13/2016

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Directions to “ADVENT MEDICAL CORP ” Practice Location

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