# MD21 GLOBAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** AvanceMD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932821733
- **Authorized official:** DR. TARA DALL MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (888) 498-5296

## Contact information

- **Practice address:** 601 GENESEE ST UNIT 303, DELAFIELD, WI 53018-1410
- **Practice address phone:** (888) 498-5296
- **Practice address fax:** (888) 495-8194
- **Mailing address:** 601 GENESEE ST UNIT 303, DELAFIELD, WI 53018-1410
- **Mailing address phone:** (888) 498-5296
- **Mailing address fax:** (888) 495-8194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/19/2022
- **Last updated:** 09/19/2022