Healthcare Provider Details

I. General information

NPI: 1770727893
Provider Name (Legal Business Name): EVANSVILLE ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MARY ST
EVANSVILLE IN
47710-1677
US

IV. Provider business mailing address

520 MARY ST
EVANSVILLE IN
47710-1677
US

V. Phone/Fax

Practice location:
  • Phone: 812-473-0181
  • Fax: 812-473-5822
Mailing address:
  • Phone: 812-340-4517
  • Fax: 812-473-5822

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. DANIEL BONHAM
Title or Position: PRESIDENT
Credential: MD
Phone: 847-691-9080