Provider Demographics
NPI:1659345791
Name:PALOS ANESTHESIA ASSOCIATES, S.C
Entity Type:Organization
Organization Name:PALOS ANESTHESIA ASSOCIATES, S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOBCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-923-5700
Mailing Address - Street 1:PO BOX 239D
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8018
Mailing Address - Country:US
Mailing Address - Phone:847-759-1560
Mailing Address - Fax:847-803-1006
Practice Address - Street 1:12251 S 80TH AVE
Practice Address - Street 2:PALOS COMMUNITY HOSPITAL
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1256
Practice Address - Country:US
Practice Address - Phone:708-923-5700
Practice Address - Fax:708-923-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
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
ILCN0735OtherRR MEDICARE GROUP#
IL01617209OtherBS GROUP #
IL01617209OtherBS GROUP #