1659306272 NPI number — AMBULATORY ANESTHESIOLOGISTS OF CHICAGO, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659306272 NPI number — AMBULATORY ANESTHESIOLOGISTS OF CHICAGO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBULATORY ANESTHESIOLOGISTS OF CHICAGO, LLC
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:
1659306272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60188-8386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-291-7432
Provider Business Mailing Address Fax Number:
312-858-6104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 E DELAWARE PL FL 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-291-7432
Provider Business Practice Location Address Fax Number:
877-235-5009
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIOKEMEISTER
Authorized Official First Name:
JAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-787-2998

Provider Taxonomy Codes

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

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





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