Healthcare Provider Details

I. General information

NPI: 1477502367
Provider Name (Legal Business Name): ALLIANCE ANESTHESIOLOGISTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 N WESTERN AVE
CHICAGO IL
60645-1812
US

IV. Provider business mailing address

185 PENNY AVE
EAST DUNDEE IL
60118-1454
US

V. Phone/Fax

Practice location:
  • Phone: 773-743-6700
  • Fax:
Mailing address:
  • Phone: 847-836-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENDALL R. LUTZ
Title or Position: BILLING MANAGER
Credential:
Phone: 847-836-7015