Healthcare Provider Details

I. General information

NPI: 1033644653
Provider Name (Legal Business Name): MARRI ANESTHETICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 PASQUINELLI DR
WESTMONT IL
60559-1276
US

IV. Provider business mailing address

1121 LAKE COOK RD STE M
DEERFIELD IL
60015-5234
US

V. Phone/Fax

Practice location:
  • Phone: 630-654-2515
  • Fax: 630-654-9344
Mailing address:
  • Phone: 847-945-4550
  • Fax: 847-948-8103

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: RAGHU SHANTAN REDDY MARRI
Title or Position: OWNER
Credential: MD
Phone: 630-776-4711