Healthcare Provider Details

I. General information

NPI: 1649685751
Provider Name (Legal Business Name): STRATEGY ANESTHESIA ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 S MADISON ST SUITE 102
WILLOWBROOK IL
60527-5510
US

IV. Provider business mailing address

19644 CLUB HOUSE RD
MONTGOMERY VILLAGE MD
20886-3047
US

V. Phone/Fax

Practice location:
  • Phone: 630-325-8684
  • Fax:
Mailing address:
  • Phone: 703-665-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KASHIF IRFAN
Title or Position: OWNER
Credential: M.D
Phone: 703-665-3046