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General NPI Number Information
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NPI Number | 1649457334
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Entity Type | Organization
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Legal Business Name | PARK ANESTHESIA, LLC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 151 DUNDEE AVE
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City | EAST DUNDEE
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State | IL
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Zip | 60118-1648
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Country | US
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Telephone | 847-551-9601
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Fax |
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Provider Business Mailing Address
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Address Line | 541 OTIS BOWEN DR
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City | MUNSTER
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State | IN
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Zip | 46321-4158
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Country | US
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Telephone | 219-934-5300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BAROUKH LEVI
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Credential | MD
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Telephone | 219-934-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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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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