Healthcare Provider Details

I. General information

NPI: 1679730394
Provider Name (Legal Business Name): MILLENIUM ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STRAIGHT STREET
CINCINNATI OH
45219
US

IV. Provider business mailing address

20 MEDICAL VILLAGE DRIVE #258
EDGEWOOD KY
41017-5411
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-7246
  • Fax: 859-341-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS P SOBOLEWSKI
Title or Position: PRESIDENT
Credential: MD
Phone: 859-341-7246