Organization
AXIS PHYSICAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL HAUSCH DC (MEDICAL DIRECTOR)
(773) 239-7165
Entity
Organization
Contact information
Practice address
11005 S KEDZIE AVE, CHICAGO, IL 60655
(773) 239-7165
Mailing address
11005 S KEDZIE AVE, CHICAGO, IL 60655
(773) 239-7165
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070020316
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400120638
PTAN/MEDICARE
IL
Enumeration date
06/12/2014
Last updated
08/25/2014
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