NPI 1619213170 · live from the CMS NPI Registry
Advanced Health Institute South Loop LLC
Family Medicine in Chicago, IL. National Provider Identifier 1619213170, active.
NPI record
| NPI | 1619213170 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 1147 S Wabash Ave Ste 250, Chicago, IL 60605 |
| Practice phone | 312-987-4878 |
| Enumerated | January 2, 2013 |
| Last updated | April 18, 2014 |
| Authorized official | Matthew Walker, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | 209011079 (IL) |
| Chiropractor | 111N00000X | 038011556 (IL) |
| Physical Medicine & Rehabilitation | 208100000X | 036112926 (IL) |
| General Practice | 208D00000X | 036060139 (IL) |
| Physician Assistant | 363A00000X | 085003927 (IL) |
| Family Medicine primary | 207Q00000X | 036134095 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.