MEDICARE: ADVANCED WELLNESS INSTITUTE

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1629272612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WELLNESS INSTITUTE

Provider Business Mailing Address
First Line	:	1902 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4204
Country	:	US
Telephone Number	:	773-927-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4204
Country	:	US
Telephone Number	:	773-927-2400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JILL PATINO
Credential	:
Telephone Number	:	773-927-2400

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/22/2020

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