MEDICARE: PREFERRED MEDICAL CENTER

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	207L00000X	Anesthesiology Physician	036101899	IL

General Provider Information

NPI Number	:	1417379785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED MEDICAL CENTER

Provider Business Mailing Address
First Line	:	314 W ROLLINS RD STE B
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1204
Country	:	US
Telephone Number	:	847-546-4220
Fax Number	:	847-546-4262

Provider Business Practice Location Address
First Line	:	314 W ROLLINS RD STE B
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1204
Country	:	US
Telephone Number	:	847-546-4220
Fax Number	:	847-546-4262

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	DR. DANIEL M. VANDERWEIT
Credential	:	DC
Telephone Number	:	847-546-4220

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	04/14/2014

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Directions to “PREFERRED MEDICAL CENTER ” Practice Location

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