Healthcare Provider Details

I. General information

NPI: 1912501560
Provider Name (Legal Business Name): CHICAGO ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 W DEVON AVE
CHICAGO IL
60659-3581
US

IV. Provider business mailing address

2122 W DEVON AVE
CHICAGO IL
60659-3581
US

V. Phone/Fax

Practice location:
  • Phone: 708-691-8841
  • Fax:
Mailing address:
  • Phone: 708-691-8841
  • Fax:

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: MR. SCHOEB MOHIUDDIN
Title or Position: OWNER
Credential: MD
Phone: 773-317-4888