Basic Information
| Provider Information | |||||||||
| NPI: | 1053473041 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADISON AVENUE ANESTHESIA PLACEMENT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20201 CRAWFORD AVE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085033857 | ||||||||
| FaxNumber: | 7086792419 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W COURT ST | ||||||||
| Address2: | |||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609013661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159372400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RADONJIC | ||||||||
| AuthorizedOfficialFirstName: | NENAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8157256331 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | JD, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.