Organization · NPI-2

Advanced Health Institute South Loop LLC

Family Medicine · Chicago, IL

NPI number1619213170
StatusActive
Last updated in NPPESApr 18, 2014

Details

NPI
1619213170
Entity type
Organization (NPI-2)
Legal business name
Advanced Health Institute South Loop LLC
Organization subpart
No
Enumeration date
Jan 2, 2013
Last updated
Apr 18, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine036134095ILYes
363L00000X Nurse Practitioner209011079IL
111N00000X Chiropractor038011556IL
208100000X Physical Medicine & Rehabilitation036112926IL
208D00000X General Practice036060139IL
363A00000X Physician Assistant085003927IL

Practice location

1147 S Wabash Ave Ste 250
Chicago, IL 60605-2355

Phone 312-987-4878 · Fax 312-235-0900

Mailing address

1147 S Wabash Ave Ste 250
Chicago, IL 60605-2355

Phone 312-987-4878 · Fax 312-235-0909

Authorized official

Matthew Walker
Ceo
8479102567

Is something wrong?

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