Healthcare Provider Details

I. General information

NPI: 1326224270
Provider Name (Legal Business Name): AMERICAN ANESTHESIOLOGY OF ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 BROADWAY
MERRILLVILLE IN
46410-7035
US

IV. Provider business mailing address

PO BOX 1278
BEDFORD PARK IL
60499-1278
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-3839
  • Fax: 844-636-1410
Mailing address:
  • Phone: 800-243-3839
  • Fax: 844-636-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RONALD HAYES
Title or Position: PRESIDENT
Credential: M.D
Phone: 800-243-3839