Provider Demographics
NPI:1154731362
Name:ADVANCED DIGESTIVE CARE OF STUART
Entity type:Organization
Organization Name:ADVANCED DIGESTIVE CARE OF STUART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMITABH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-219-2500
Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-219-2500
Mailing Address - Fax:772-463-4677
Practice Address - Street 1:1050 SE MONTEREY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-219-2500
Practice Address - Fax:772-463-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70846174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty