MEDICARE: ADVANCED EAR NOSE & THROAT SPECIALISTS, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1518787613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED EAR NOSE & THROAT SPECIALISTS, SC

Provider Business Mailing Address
First Line	:	10001 W INNOVATION DR STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4851
Country	:	US
Telephone Number	:	888-938-3838
Fax Number	:	888-919-1083

Provider Business Practice Location Address
First Line	:	3333 ASPEN GROVE DR STE 100
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-4875
Country	:	US
Telephone Number	:	888-938-3838
Fax Number	:	888-919-1083

Authorized Official
Title or Position	:	CEO
Name	:	MADAN N KANDULA
Credential	:	MD
Telephone Number	:	414-771-6780

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/21/2024

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