Provider Demographics
NPI:1063702991
Name:ADVANCED ALTERNATIVE MED CARE
Entity type:Organization
Organization Name:ADVANCED ALTERNATIVE MED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:OLIVIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-473-5994
Mailing Address - Street 1:9651 W 153RD ST
Mailing Address - Street 2:STE. 55
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3773
Mailing Address - Country:US
Mailing Address - Phone:708-675-1908
Mailing Address - Fax:708-460-5615
Practice Address - Street 1:9651 W 153RD ST
Practice Address - Street 2:STE, 55
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3773
Practice Address - Country:US
Practice Address - Phone:708-675-1908
Practice Address - Fax:708-460-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001829101YP2500X
IL036073886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty