Provider Demographics
NPI:1841552999
Name:ADVANCED LIVER AND GASTROINTESTINAL DISEASE CENTER LLC
Entity type:Organization
Organization Name:ADVANCED LIVER AND GASTROINTESTINAL DISEASE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:VANTHIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-573-1633
Mailing Address - Street 1:401 E ONTARIO ST
Mailing Address - Street 2:SUITE#4005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3051
Mailing Address - Country:US
Mailing Address - Phone:312-573-1633
Mailing Address - Fax:
Practice Address - Street 1:3245 GROVE AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3474
Practice Address - Country:US
Practice Address - Phone:414-236-7224
Practice Address - Fax:708-290-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL036096121207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Single Specialty