MEDICARE: PAINLESS ANESTHESIA PROVIDERS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01636192	OTHER	IL	BLUE SHIELD PROVIDER NUMB

General Provider Information

NPI Number	:	1558432575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAINLESS ANESTHESIA PROVIDERS S. C.

Provider Business Mailing Address
First Line	:	2333 N HARLEM AVE
Second Line	:	SUITE 500
City	:	CHICAGO
State	:	IL
Zip	:	60707-2718
Country	:	US
Telephone Number	:	773-637-1700
Fax Number	:	773-637-2881

Provider Business Practice Location Address
First Line	:	2333 N HARLEM AVE
Second Line	:	SUITE 500
City	:	CHICAGO
State	:	IL
Zip	:	60707-2718
Country	:	US
Telephone Number	:	773-637-1700
Fax Number	:	773-637-2881

Authorized Official
Title or Position	:	BILLING COLLECTION
Name	:	MS. GERDA KULKA
Credential	:
Telephone Number	:	773-637-1700

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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