Healthcare Provider Details

I. General information

NPI: 1396887774
Provider Name (Legal Business Name): MOBILE ANESTHESIOLOGISTS CHICAGO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 W HIGGINS RD STE 1100
ROSEMONT IL
60018-4962
US

IV. Provider business mailing address

9550 W HIGGINS RD STE 1100
ROSEMONT IL
60018-4962
US

V. Phone/Fax

Practice location:
  • Phone: 773-355-5300
  • Fax: 773-355-5304
Mailing address:
  • Phone: 773-355-5300
  • Fax: 773-355-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSHUA GANTZ
Title or Position: CFO
Credential:
Phone: 773-756-5760