Basic Information
| Provider Information | |||||||||
| NPI: | 1437151057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIVISION ANESTHESIA GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 E 22ND ST | ||||||||
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| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601486110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308742542 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2233 W DIVISION ST | ||||||||
| Address2: | ST. MARY OF NAZARETH HOSPITAL / ANESTHESIA DEPARTMENT | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606223043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127702000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | KIM | ||||||||
| AuthorizedOfficialFirstName: | EUN | ||||||||
| AuthorizedOfficialMiddleName: | KYUNG | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 3127702000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.