Provider Demographics
NPI:1962781252
Name:ASHLAND AVENUE GI, S.C.
Entity type:Organization
Organization Name:ASHLAND AVENUE GI, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEIKHOSROW
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZANFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-871-4600
Mailing Address - Street 1:3004 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3012
Mailing Address - Country:US
Mailing Address - Phone:773-871-4600
Mailing Address - Fax:773-871-2900
Practice Address - Street 1:3004 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-871-4600
Practice Address - Fax:773-871-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy