MEDICARE: METRO ANESTHESIA CONSULTANTS LLC

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	:	1669653580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO ANESTHESIA CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	195 N HARBOR DR
Second Line	:	SUITE 3302
City	:	CHICAGO
State	:	IL
Zip	:	60601-7514
Country	:	US
Telephone Number	:	312-540-0130
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 N HARBOR DR
Second Line	:	SUITE 3302
City	:	CHICAGO
State	:	IL
Zip	:	60601-7514
Country	:	US
Telephone Number	:	312-540-0130
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JILL NANDRA
Credential	:
Telephone Number	:	312-540-0130

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	11/20/2007

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