Healthcare Provider Details

I. General information

NPI: 1952308223
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 HANFORD LN
AURORA IL
60502-6969
US

IV. Provider business mailing address

350 S NORTHWEST HWY
PARK RIDGE IL
60068-4216
US

V. Phone/Fax

Practice location:
  • Phone: 815-748-8993
  • Fax:
Mailing address:
  • Phone: 847-720-7457
  • Fax: 847-720-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number999999999
License Number StateIL

VIII. Authorized Official

Name: MICHAEL COULSON
Title or Position: OWNER
Credential: D.O.
Phone: 815-748-8993