Provider Demographics
NPI:1538223060
Name:ADVANCED GASTROENTEROLOGY PC
Entity type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLUWALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-733-0500
Mailing Address - Street 1:2971 W ELLIOT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1636
Mailing Address - Country:US
Mailing Address - Phone:480-733-0500
Mailing Address - Fax:480-733-7080
Practice Address - Street 1:2971 W ELLIOT RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1636
Practice Address - Country:US
Practice Address - Phone:480-733-0500
Practice Address - Fax:480-733-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30933207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72809Medicare PIN