Provider Demographics
NPI:1306867056
Name:LAKE COUNTY ANESTHESIOLOGISTS LTD
Entity Type:Organization
Organization Name:LAKE COUNTY ANESTHESIOLOGISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:THUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-868-2200
Mailing Address - Street 1:387 SHUMAN BLVD STE 240W
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8113
Mailing Address - Country:US
Mailing Address - Phone:630-868-2200
Mailing Address - Fax:
Practice Address - Street 1:800 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3254
Practice Address - Country:US
Practice Address - Phone:800-444-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL900200Medicare ID - Type Unspecified