MEDICARE: CARDINAL ANESTHESIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1134570153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	51050 BITTERSWEET RD
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-7879
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51050 BITTERSWEET RD
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-7879
Country	:	US
Telephone Number	:	718-208-0446
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	RONI AIZIGOV
Credential	:	CRNA
Telephone Number	:	718-208-0446

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	10/04/2023

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