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General NPI Number Information
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NPI Number | 1033644653
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Entity Type | Organization
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Legal Business Name | MARRI ANESTHETICS LTD
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 815 PASQUINELLI DR
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City | WESTMONT
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State | IL
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Zip | 60559-1276
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Country | US
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Telephone | 630-654-2515
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Fax | 630-654-9344
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Provider Business Mailing Address
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Address Line | 1121 LAKE COOK RD STE M
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City | DEERFIELD
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State | IL
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Zip | 60015-5234
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Country | US
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Telephone | 847-945-4550
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Fax | 847-948-8103
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Authorized Official
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Title or Position | OWNER
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Name | RAGHU SHANTAN REDDY MARRI
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Credential | MD
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Telephone | 630-776-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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