Healthcare Provider Details

I. General information

NPI: 1215783766
Provider Name (Legal Business Name): REDREEF ANESTHESIA ASSOCIATES CHARTERED INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST
GARY IN
46402-6001
US

IV. Provider business mailing address

PO BOX 88848
CAROL STREAM IL
60188-0848
US

V. Phone/Fax

Practice location:
  • Phone: 888-851-4642
  • Fax:
Mailing address:
  • Phone: 888-851-4642
  • 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. RONALD HAYES
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 815-651-9729