Join Our Network

Thank you for your interest in becoming part of the HealthTeam Advantage Provider network. Please complete the form below.

* Indicates required fields
Physician Name*
Specialty*
Individual NPI#*
Individual NPI#*
Group NPI#*
Tax ID#*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Name
First Last
Phone
Email*
Enter Email Confirm Email
Message
CAPTCHA