Provider Demographics
NPI:1063500387
Name:ADVANCED DIABETES & ENDOCRINCE CENTER, P.C.
Entity Type:Organization
Organization Name:ADVANCED DIABETES & ENDOCRINCE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARHOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-573-9455
Mailing Address - Street 1:755 S. MILWAUKEE AVE
Mailing Address - Street 2:SUITE 186
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-573-9455
Mailing Address - Fax:
Practice Address - Street 1:755 S. MILWAUKEE AVE
Practice Address - Street 2:SUITE 186
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-573-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty