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General NPI Number Information
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NPI Number | 1174142251
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Entity Type | Organization
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Legal Business Name | GREATER CHICAGO ANESTHESIA LLC
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 2937 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60629-2753
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Country | US
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Telephone | 773-309-0141
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 486
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City | LAKE FOREST
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State | IL
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Zip | 60045-0486
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Country | US
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Telephone | 847-457-3800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN ROSENTHAL
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Credential | MD
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Telephone | 312-933-4149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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