Healthcare Provider Details

I. General information

NPI: 1558987883
Provider Name (Legal Business Name): ENCORE ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ERIE CT
OAK PARK IL
60302-2519
US

IV. Provider business mailing address

PO BOX 809083
CHICAGO IL
60680-9083
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-6200
  • Fax:
Mailing address:
  • Phone: 800-516-5315
  • Fax: 517-787-7365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMIR H NAVIK
Title or Position: AUHTORIZED REPRESENTATIVE
Credential: MD
Phone: 217-553-8966