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General NPI Number Information
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NPI Number | 1215759501
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Entity Type | Organization
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Legal Business Name | ALLIANCE GASTROENTEROLOGY GROUP LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1795 N BUTTERFIELD RD STE 201
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-1212
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Country | US
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Telephone | 847-500-9380
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Fax | 833-523-2430
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Provider Business Mailing Address
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Address Line | 6 BROADLEYS CT
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City | BANNOCKBURN
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State | IL
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Zip | 60015-1511
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Country | US
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Telephone | 847-909-2088
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DALIA THOMAS
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Credential |
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Telephone | 847-909-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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