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General NPI Number Information
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NPI Number | 1518787613
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Entity Type | Organization
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Legal Business Name | ADVANCED EAR NOSE & THROAT SPECIALISTS, SC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3333 ASPEN GROVE DR STE 100
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City | FRANKLIN
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State | TN
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Zip | 37067-4875
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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 | MADAN N KANDULA
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Credential | MD
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Telephone | 414-771-6780
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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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