MEDICARE: MID AMERICA ANESTHESIA 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	:	1679758288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID AMERICA ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	912 SAINT STEPHENS GRN
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-2568
Country	:	US
Telephone Number	:	630-926-3096
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4532
Country	:	US
Telephone Number	:	773-889-2000
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	NARAYANARAO RAVISHANKAR
Credential	:	M.D
Telephone Number	:	630-926-3096

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	01/02/2008

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Directions to “MID AMERICA ANESTHESIA LLC ” Practice Location

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