Basic Information
| Provider Information | |||||||||
| NPI: | 1447843388 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IHC-WHEATON ANESTHESIA LLC | ||||||||
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| Address1: | 7600 W SUNRISE BLVD FL 1 | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333224115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732511132 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10148 S 27TH ST | ||||||||
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| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531545528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178892040 | ||||||||
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| ProviderEnumerationDate: | 02/11/2021 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | KONDAS | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 9732511132 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.