Healthcare Provider Details

I. General information

NPI: 1629748181
Provider Name (Legal Business Name): GOLD COAST ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W GRAND AVE UNIT 324
CHICAGO IL
60654
US

IV. Provider business mailing address

301 W GRAND AVE UNIT 324
CHICAGO IL
60654-4640
US

V. Phone/Fax

Practice location:
  • Phone: 248-342-6480
  • Fax: 708-452-1444
Mailing address:
  • Phone: 248-342-6480
  • Fax: 708-452-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SHAWN KUMAR
Title or Position: OWNER
Credential: MD
Phone: 248-342-6480