Provider Demographics
NPI:1649451915
Name:ADVANCED GASTROENTEROLOGY LLC
Entity type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZA
Authorized Official - Middle Name:SAJJAD
Authorized Official - Last Name:HAMDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-882-9303
Mailing Address - Street 1:759 JOHN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4717
Mailing Address - Country:US
Mailing Address - Phone:630-882-9303
Mailing Address - Fax:630-882-9304
Practice Address - Street 1:759 JOHN ST
Practice Address - Street 2:SUITE C
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-4717
Practice Address - Country:US
Practice Address - Phone:630-882-9303
Practice Address - Fax:630-882-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074563207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E97600Medicare UPIN