MEDICARE: ANESTHESIA ASSOCIATES, LTD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	999999999	IL

General Provider Information

NPI Number	:	1952308223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA ASSOCIATES, LTD

Provider Business Mailing Address
First Line	:	350 S NORTHWEST HWY
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-4216
Country	:	US
Telephone Number	:	847-720-7457
Fax Number	:	847-720-7102

Provider Business Practice Location Address
First Line	:	2540 HANFORD LN
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60502-6969
Country	:	US
Telephone Number	:	815-748-8993
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL COULSON
Credential	:	D.O.
Telephone Number	:	815-748-8993

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	08/19/2009

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