Provider Demographics
NPI:1891174983
Name:ADVOCATE MEDICAL GROUP
Entity Type:Organization
Organization Name:ADVOCATE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR, NURSE-MIDWIFERY SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:LISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:773-296-3098
Mailing Address - Street 1:3048 N WILTON AVE
Mailing Address - Street 2:3RD FLOOR, NURSE-MIDWIFERY SERVICE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6710
Mailing Address - Country:US
Mailing Address - Phone:773-296-7032
Mailing Address - Fax:773-296-3096
Practice Address - Street 1:3048 N WILTON AVE
Practice Address - Street 2:3RD FLOOR, NURSE-MIDWIFERY SERVICE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6710
Practice Address - Country:US
Practice Address - Phone:773-296-7032
Practice Address - Fax:773-296-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012585367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty