Provider Demographics
NPI:1629332226
Name:AMERICAN COLONOSCOPY AND ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:AMERICAN COLONOSCOPY AND ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-232-2025
Mailing Address - Street 1:2631 WILLIAMSBURG AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1127
Mailing Address - Country:US
Mailing Address - Phone:630-232-2025
Mailing Address - Fax:
Practice Address - Street 1:2631 WILLIAMSBURG AVE STE 301
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1127
Practice Address - Country:US
Practice Address - Phone:630-232-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical