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General NPI Number Information
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NPI Number | 1366620064
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Entity Type | Organization
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Legal Business Name | ADVANCED AESTHETICS SURGERY & LASER CENTER, P.C.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 2111 WEST PARK CT.
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City | CHAMPAIGN
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State | IL
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Zip | 61821
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Country | US
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Telephone | 217-356-3850
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Fax | 217-356-3876
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Provider Business Mailing Address
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Address Line | 1702 MULLIKIN DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-8305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | DR. JAMES M KURLEY
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Credential | M.D.
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Telephone | 217-356-3850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 060.007842
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License Number State | IL
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