MEDICARE: PROFESSIONAL ANESTHESIA, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician
2	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1174572218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL ANESTHESIA, S.C.

Provider Business Mailing Address
First Line	:	185 PENNY AVE
Second Line	:
City	:	EAST DUNDEE
State	:	IL
Zip	:	60118-1454
Country	:	US
Telephone Number	:	847-836-7015
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 ERIE CT
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-2519
Country	:	US
Telephone Number	:	708-383-6200
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. KENDALL R. LUTZ
Credential	:
Telephone Number	:	847-836-7015

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	09/11/2025

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