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General NPI Number Information
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NPI Number | 1619965266
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Entity Type | Organization
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Legal Business Name | ASSOCIATED GASTROENTEROLOGY CONSULTANTS, INC.
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 530 PARK AVE E SUITE 207
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City | PRINCETON
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State | IL
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Zip | 61356-3901
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Country | US
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Telephone | 815-875-8666
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Fax | 815-872-0487
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Provider Business Mailing Address
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Address Line | 530 PARK AVE E SUITE 207
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City | PRINCETON
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State | IL
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Zip | 61356-3901
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Country | US
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Telephone | 815-875-8666
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Fax | 815-872-0487
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. GINA DORAN
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Credential |
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Telephone | 815-875-7666
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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 | 209005803
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036085799
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036062499
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License Number State | IL
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