Provider Demographics
NPI:1215759501
Name:ALLIANCE GASTROENTEROLOGY GROUP LLC
Entity type:Organization
Organization Name:ALLIANCE GASTROENTEROLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-909-2088
Mailing Address - Street 1:6 BROADLEYS CT
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1511
Mailing Address - Country:US
Mailing Address - Phone:847-909-2088
Mailing Address - Fax:
Practice Address - Street 1:1795 N BUTTERFIELD RD STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1212
Practice Address - Country:US
Practice Address - Phone:847-500-9380
Practice Address - Fax:833-523-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty