Provider Demographics
NPI:1417560491
Name:ADVANCED MEDICAL STRATEGIES LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL STRATEGIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOOKICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-224-2790
Mailing Address - Street 1:3646 WIRTH RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2218
Mailing Address - Country:US
Mailing Address - Phone:219-678-0130
Mailing Address - Fax:219-300-5858
Practice Address - Street 1:3646 WIRTH RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2218
Practice Address - Country:US
Practice Address - Phone:219-678-0130
Practice Address - Fax:219-300-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty