Organization
ADVANCED GI IMAGING & DIAGNOSTIC CENTER,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL P SHALLMAN M.D. (M.D.)
(562) 704-2171
Entity
Organization
Contact information
Practice address
1045 ATLANTIC AVE, SUITE 708, LONG BEACH, CA 90813-3408
(562) 437-0719
(562) 432-0503
Mailing address
PO BOX 797, LOS ALAMITOS, CA 90720-0797
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G35328
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ502532
BLUE SHIELD
CA
Enumeration date
08/09/2007
Last updated
04/22/2008
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