Healthcare Provider Details

I. General information

NPI: 1346282522
Provider Name (Legal Business Name): ANESTHESIOLOGY CONSULTANTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE
NORMAL IL
61761-3551
US

IV. Provider business mailing address

PO BOX 5997
PEORIA IL
61601-5997
US

V. Phone/Fax

Practice location:
  • Phone: 309-454-1400
  • Fax:
Mailing address:
  • Phone: 847-615-2200
  • Fax: 847-615-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number042616733
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042616733
License Number StateIL

VIII. Authorized Official

Name: BENJAMIN TAIMOORAZY
Title or Position: PRESIDENT
Credential: MD
Phone: 309-454-1400