Basic Information
Provider Information | |||||||||
NPI: | 1396189411 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CONSULTING ANESTHESIOLOGISTS LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 925 SHERWOOD DR | ||||||||
Address2: |   | ||||||||
City: | LAKE BLUFF | ||||||||
State: | IL | ||||||||
PostalCode: | 600442203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8004446110 | ||||||||
FaxNumber: | 8887358731 | ||||||||
Practice Location | |||||||||
Address1: | 1302 FRANKLIN AVE | ||||||||
Address2: |   | ||||||||
City: | NORMAL | ||||||||
State: | IL | ||||||||
PostalCode: | 617613551 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3092683400 | ||||||||
FaxNumber: | 3092683423 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2013 | ||||||||
LastUpdateDate: | 04/19/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HOLST | ||||||||
AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
AuthorizedOfficialTelephone: | 3098466469 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.