Provider Demographics
NPI:1164851333
Name:NORTHSTAR ANESTHESIA
Entity Type:Organization
Organization Name:NORTHSTAR ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ANESTHESIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-865-2141
Mailing Address - Street 1:837 ADRIENNE AVE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4792
Mailing Address - Country:US
Mailing Address - Phone:815-830-3870
Mailing Address - Fax:
Practice Address - Street 1:837 ADRIENNE AVE
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4792
Practice Address - Country:US
Practice Address - Phone:815-830-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28212324A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital