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General NPI Number Information
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NPI Number | 1134570153
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Entity Type | Organization
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Legal Business Name | CARDINAL ANESTHESIA, LLC
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 51050 BITTERSWEET RD
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City | GRANGER
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State | IN
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Zip | 46530-7879
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Country | US
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Telephone | 718-208-0446
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Fax |
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Provider Business Mailing Address
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Address Line | 51050 BITTERSWEET RD
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City | GRANGER
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State | IN
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Zip | 46530-7879
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | RONI AIZIGOV
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Credential | CRNA
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Telephone | 718-208-0446
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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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