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General NPI Number Information
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NPI Number | 1184281735
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Entity Type | Organization
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Legal Business Name | ADVANCED EAR NOSE & THROAT SPECIALISTS, PLLC
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 925 N MILWAUKEE AVE UNIT 200
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City | VERNON HILLS
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State | IL
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Zip | 60061-1637
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Country | US
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Telephone | 888-938-3838
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Fax | 888-919-1083
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Provider Business Mailing Address
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Address Line | 10001 W INNOVATION DR STE 200
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City | MILWAUKEE
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State | WI
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Zip | 53226-4851
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Country | US
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Telephone | 888-938-3838
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Fax | 888-919-1083
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Authorized Official
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Title or Position | CEO
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Name | DR. MADAN KANDULA
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Credential | MD
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Telephone | 888-938-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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