Provider Demographics
NPI:1811231715
Name:ADVANCED BREAST CARE CENTER
Entity Type:Organization
Organization Name:ADVANCED BREAST CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-393-7777
Mailing Address - Street 1:27472 SCHOENHERR RD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6688
Mailing Address - Country:US
Mailing Address - Phone:586-393-7777
Mailing Address - Fax:586-777-1533
Practice Address - Street 1:27472 SCHOENHERR RD
Practice Address - Street 2:SUITE #108
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6688
Practice Address - Country:US
Practice Address - Phone:586-393-7777
Practice Address - Fax:586-777-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044119208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty