Healthcare Provider Details

I. General information

NPI: 1144722802
Provider Name (Legal Business Name): MIDWEST ANESTHESIA AND PAIN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10181 W LINCOLN HWY
FRANKFORT IL
60423-1274
US

IV. Provider business mailing address

PO BOX 156
FRANKFORT IL
60423-0156
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-7212
  • Fax: 888-770-6360
Mailing address:
  • Phone: 815-464-7212
  • Fax: 888-770-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: ZAKI ANWAR
Title or Position: MEMBER
Credential:
Phone: 815-464-7212