1396887774 NPI number — MOBILE ANESTHESIOLOGISTS CHICAGO PLLC

Table of content: MICHAEL THOMAS HEAPS CRNA (NPI 1629033451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396887774 NPI number — MOBILE ANESTHESIOLOGISTS CHICAGO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE ANESTHESIOLOGISTS CHICAGO PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396887774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9550 W HIGGINS RD STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60018-4962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-355-5300
Provider Business Mailing Address Fax Number:
773-355-5304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9550 W HIGGINS RD STE 1100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60018-4962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-355-5300
Provider Business Practice Location Address Fax Number:
773-355-5304
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GANTZ
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
773-756-5760

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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