Healthcare Provider Details

I. General information

NPI: 1992523047
Provider Name (Legal Business Name): ACCESS ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 N LAKE SHORE DR APT 3D
CHICAGO IL
60613-3457
US

IV. Provider business mailing address

3900 N LAKE SHORE DR APT 3D
CHICAGO IL
60613-3457
US

V. Phone/Fax

Practice location:
  • Phone: 408-775-4140
  • Fax: 312-312-9689
Mailing address:
  • Phone: 408-775-4140
  • Fax: 312-312-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: ARASH JAMILPANAH
Title or Position: OWNER
Credential:
Phone: 408-775-4140