MEDICARE: ADVANTAGE MEDICAL GROUP S.C.

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician		IL

General Provider Information

NPI Number	:	1336225317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE MEDICAL GROUP S.C.

Provider Business Mailing Address
First Line	:	12770 S. HARLEM AVENUE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2145
Country	:	US
Telephone Number	:	708-923-0636
Fax Number	:	708-923-0669

Provider Business Practice Location Address
First Line	:	12770 S HARLEM AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2145
Country	:	US
Telephone Number	:	708-923-0636
Fax Number	:	708-923-0669

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN HAUSER
Credential	:	D.C.
Telephone Number	:	708-923-0636

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/22/2020

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