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NPI Code Detail

MEDICARE: DIVISION ANESTHESIA GROUP PC

MEDICARE: DIVISION ANESTHESIA GROUP PC
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
1367500000XCertified Registered Nurse Anesthetist
2207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1437151057
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVISION ANESTHESIA GROUP PC
Provider Business Mailing Address
First Line : 520 E 22ND ST
Second Line :
City : LOMBARD
State : IL
Zip : 60148-6110
Country : US
Telephone Number : 630-874-2542
Fax Number :
Provider Business Practice Location Address
First Line : 2233 W DIVISION ST
Second Line : ST. MARY OF NAZARETH HOSPITAL / ANESTHESIA DEPARTMENT
City : CHICAGO
State : IL
Zip : 60622-3043
Country : US
Telephone Number : 312-770-2000
Fax Number :
Authorized Official
Title or Position : CHAIRMAN
Name : EUN KYUNG KIM
Credential : M.D.
Telephone Number : 312-770-2000
Provider Enumeration Date : 08/12/2005
Last Update Date : 07/16/2007

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