Provider Demographics
NPI:1033644653
Name:MARRI ANESTHETICS LTD
Entity Type:Organization
Organization Name:MARRI ANESTHETICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU SHANTAN
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:MARRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-776-4711
Mailing Address - Street 1:1121 LAKE COOK RD STE M
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5234
Mailing Address - Country:US
Mailing Address - Phone:847-945-4550
Mailing Address - Fax:847-948-8103
Practice Address - Street 1:815 PASQUINELLI DR
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1276
Practice Address - Country:US
Practice Address - Phone:630-654-2515
Practice Address - Fax:630-654-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty