Provider Demographics
NPI:1659306272
Name:AMBULATORY ANESTHESIOLOGISTS OF CHICAGO, LLC
Entity Type:Organization
Organization Name:AMBULATORY ANESTHESIOLOGISTS OF CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIOKEMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-787-2998
Mailing Address - Street 1:PO BOX 809274
Mailing Address - Street 2:LBX 809274
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9274
Mailing Address - Country:US
Mailing Address - Phone:312-787-2998
Mailing Address - Fax:312-787-7259
Practice Address - Street 1:409 W HURON ST
Practice Address - Street 2:3RD FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3431
Practice Address - Country:US
Practice Address - Phone:312-787-2998
Practice Address - Fax:312-787-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204373Medicare ID - Type UnspecifiedMEDICARE PART B-DUPAGE
IL204372Medicare ID - Type UnspecifiedMEDICARE PART B- COOK