MEDICARE: ADVANCED MEDICAL SUPPLY INC

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	332B00000X	Durable Medical Equipment & Medical Supplies		IL

General Provider Information

NPI Number	:	1497794564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	3322 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4001
Country	:	US
Telephone Number	:	773-205-6993
Fax Number	:	773-205-6994

Provider Business Practice Location Address
First Line	:	3322 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4001
Country	:	US
Telephone Number	:	773-205-6993
Fax Number	:	773-205-6994

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OLEG KACHEROV
Credential	:
Telephone Number	:	773-205-6993

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	02/04/2008

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