Provider Demographics
NPI:1922294727
Name:ADVANCED MINIMALLY INVASIVE SURGERY, LLC
Entity Type:Organization
Organization Name:ADVANCED MINIMALLY INVASIVE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BONHEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-327-4444
Mailing Address - Street 1:32 STRAWBERRY HILL CT STE 41052
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2777
Mailing Address - Country:US
Mailing Address - Phone:203-327-4444
Mailing Address - Fax:203-724-4484
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:SUITE 41052
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-327-4444
Practice Address - Fax:203-724-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-15
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008054020Medicaid