| Advanced Endometriosis Center | |
|
3033 Ogden Ave Ste 300 Lisle IL 60532-1976 | |
| (331) 702-2455 | |
| (331) 229-8191 |
| Full Name | Advanced Endometriosis Center |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 3033 Ogden Ave Ste 300, Lisle, Illinois |
| Authorized Official Name and Position | Fadel Fons Talasoun Azer (MEMBER/OWNER) |
| Authorized Official Contact | 3317022455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Endometriosis Center 3033 Ogden Ave Ste 300 Lisle IL 60532-1976 Ph: (331) 702-2455 | Advanced Endometriosis Center 3033 Ogden Ave Ste 300 Lisle IL 60532-1976 Ph: (331) 702-2455 |
| NPI Number | 1598462426 |
|---|---|
| Provider Enumeration Date | 02/10/2023 |
| Last Update Date | 05/01/2024 |
| Medicare PECOS PAC ID | 8325412240 |
|---|---|
| Medicare Enrollment ID | O20230316000547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598462426 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207VG0400X | Obstetrics & Gynecology - Gynecology | (* (Not Available)) | Primary |
| Provider Name | Fadel Fons Talasoun Azer |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619178845 PECOS PAC ID: 7012181456 Enrollment ID: I20111121000224 |
| Provider Name | Mariam Kirollos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518272384 PECOS PAC ID: 7517193634 Enrollment ID: I20131120001137 |
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