MEDICARE: ADVANCED MEDICAL CARE CHICAGO LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1760834436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL CARE CHICAGO LLC

Provider Business Mailing Address
First Line	:	2751 W 51ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2136
Country	:	US
Telephone Number	:	847-429-0571
Fax Number	:

Provider Business Practice Location Address
First Line	:	2751 W 51ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2136
Country	:	US
Telephone Number	:	847-429-0571
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALI MATERI
Credential	:
Telephone Number	:	847-429-0571

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	07/06/2016

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