Provider Demographics
NPI:1568643336
Name:ADVANCED CENTER FOR ENDOSCOPY
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR ENDOSCOPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAITAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-551-9617
Mailing Address - Street 1:151 DUNDEE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1648
Mailing Address - Country:US
Mailing Address - Phone:847-551-9617
Mailing Address - Fax:847-551-9610
Practice Address - Street 1:151 DUNDEE AVE
Practice Address - Street 2:
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1648
Practice Address - Country:US
Practice Address - Phone:847-551-9617
Practice Address - Fax:847-551-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty