Basic Information
| Provider Information | |||||||||
| NPI: | 1306867056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKE COUNTY ANESTHESIOLOGISTS LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 387 SHUMAN BLVD STE 240W | ||||||||
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| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605638113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308682200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 S MILWAUKEE AVE | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600483254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 12/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | THUNGA | ||||||||
| AuthorizedOfficialFirstName: | RAGHU | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6308682200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.