Provider Demographics
NPI:1588947022
Name:ADVANCE VISITING PHYSICIANS LLC
Entity type:Organization
Organization Name:ADVANCE VISITING PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANCHANARYANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-286-2350
Mailing Address - Street 1:15945 19 MILE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1147
Mailing Address - Country:US
Mailing Address - Phone:586-286-2350
Mailing Address - Fax:586-286-8742
Practice Address - Street 1:15945 19 MILE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1147
Practice Address - Country:US
Practice Address - Phone:586-286-2350
Practice Address - Fax:586-286-8742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRU033666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty