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General NPI Number Information
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NPI Number | 1417149899
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Entity Type | Organization
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Legal Business Name | ADVANCED GI IMAGING & DIAGNOSTIC CENTER,INC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 1045 ATLANTIC AVE SUITE 708
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City | LONG BEACH
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State | CA
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Zip | 90813-3408
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Country | US
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Telephone | 562-437-0719
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Fax | 562-432-0503
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Provider Business Mailing Address
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Address Line | PO BOX 797
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-0797
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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 | M.D.
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Name | DR. MICHAEL P SHALLMAN
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Credential | M.D.
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Telephone | 562-704-2171
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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 | G35328
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License Number State | CA
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