MEDICARE: GOLD COAST ANESTHESIA PLLC

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

General Provider Information

NPI Number	:	1629748181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD COAST ANESTHESIA PLLC

Provider Business Mailing Address
First Line	:	301 W GRAND AVE UNIT 324
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-4640
Country	:	US
Telephone Number	:	312-724-9001
Fax Number	:	312-319-2597

Provider Business Practice Location Address
First Line	:	2335 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3225
Country	:	US
Telephone Number	:	347-927-4037
Fax Number	:	248-621-5219

Authorized Official
Title or Position	:	OWNER
Name	:	SHAWN KUMAR
Credential	:	MD
Telephone Number	:	248-342-6480

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	01/14/2026

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