For Providers Join Our Network Thank you for your interest in becoming part of the HealthTeam Advantage Provider network. Please complete the form below. * Indicates required fieldsPhysician 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 PhoneEmail* Enter Email Confirm Email MessageCAPTCHA