1992740583 NPI number — GLEN OAKS ANESTHESIOLOGISTS, SC

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 1992740583 NPI number — GLEN OAKS ANESTHESIOLOGISTS, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLEN OAKS ANESTHESIOLOGISTS, SC
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:
1992740583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
744 W MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49201-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-787-6440
Provider Business Mailing Address Fax Number:
517-787-4146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 WINTHROP AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60139-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-545-5980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANWAR
Authorized Official First Name:
ABDEL
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORISED REPRESENTATIVE
Authorized Official Telephone Number:
630-545-5980

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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