Healthcare Provider Details

I. General information

NPI: 1992754089
Provider Name (Legal Business Name): STAT ANESTHESIA SPECIALISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 HIGH RD
BREMEN IN
46506-1093
US

IV. Provider business mailing address

PO BOX 70
LAKE FOREST IL
60045-0070
US

V. Phone/Fax

Practice location:
  • Phone: 317-697-1407
  • Fax: 574-400-0283
Mailing address:
  • Phone: 800-444-6110
  • Fax: 708-895-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN SCHMUTZLER
Title or Position: PRESIDENT
Credential:
Phone: 317-697-1407