Healthcare Provider Details

I. General information

NPI: 1629194113
Provider Name (Legal Business Name): LOGAN SQUARE ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3538 W FULLERTON AVE
CHICAGO IL
60647-2443
US

IV. Provider business mailing address

PO BOX 249
WINNETKA IL
60093-0249
US

V. Phone/Fax

Practice location:
  • Phone: 773-772-1212
  • Fax: 773-772-8666
Mailing address:
  • Phone: 773-772-1212
  • Fax: 773-772-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. RAMON ANDRES GARCIA
Title or Position: PRESIDENT
Credential: MD
Phone: 773-772-1212