Healthcare Provider Details

I. General information

NPI: 1952352171
Provider Name (Legal Business Name): ANESTHESIA CONSULTANTS OF MORRIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W HIGH ST
MORRIS IL
60450-1463
US

IV. Provider business mailing address

255 W MICHIGAN AVE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 630-472-8800
  • Fax:
Mailing address:
  • Phone: 800-242-1131
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIM SANDERS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: DO
Phone: 630-472-8800