Basic Information
| Provider Information | |||||||||
| NPI: | 1144722802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST ANESTHESIA AND PAIN SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 156 | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604230156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154647212 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Practice Location | |||||||||
| Address1: | 10181 W LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604231274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154647212 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2018 | ||||||||
| LastUpdateDate: | 03/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | ANWAR | ||||||||
| AuthorizedOfficialFirstName: | ZAKI | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8154647212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.