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NPI Code Detail

MEDICARE: ADVANCED PHYSICAL MEDICINE ASSOCIATES, SC

MEDICARE: ADVANCED PHYSICAL MEDICINE ASSOCIATES, SC
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
1208100000XPhysical Medicine & Rehabilitation PhysicianIL

General Provider Information

NPI Number : 1508057092
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED PHYSICAL MEDICINE ASSOCIATES, SC
Provider Business Mailing Address
First Line : 490 W LAKE ST
Second Line : SUITE 105
City : ROSELLE
State : IL
Zip : 60172-3583
Country : US
Telephone Number : 630-924-1450
Fax Number : 630-924-1459
Provider Business Practice Location Address
First Line : 4501 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2102
Country : US
Telephone Number : 630-924-1450
Fax Number : 630-924-1459
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHN C. SARANTOPOULOS
Credential : DO
Telephone Number : 630-924-1450
Provider Enumeration Date : 08/08/2007
Last Update Date : 08/08/2007

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