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General NPI Number Information
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NPI Number | 1154731362
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Entity Type | Organization
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Legal Business Name | ADVANCED DIGESTIVE CARE OF STUART
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 1050 SE MONTEREY RD SUITE 203
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City | STUART
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State | FL
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Zip | 34994-4512
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Country | US
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Telephone | 772-219-2500
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Fax | 772-463-4677
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Provider Business Mailing Address
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Address Line | 1050 SE MONTEREY RD SUITE 203
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City | STUART
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State | FL
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Zip | 34994-4512
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Country | US
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Telephone | 772-219-2500
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Fax | 772-463-4677
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Authorized Official
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Title or Position | SOLE PROPPRIETOR
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Name | DR. AMITABH KUMAR
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Credential | M.D.
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Telephone | 772-219-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME70846
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License Number State | FL
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