Provider Demographics
NPI:1740746197
Name:FREEDOM ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:FREEDOM ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLASCZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:810-300-4688
Mailing Address - Street 1:360 W HUBBARD ST APT 1203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5748
Mailing Address - Country:US
Mailing Address - Phone:810-300-4688
Mailing Address - Fax:
Practice Address - Street 1:360 W HUBBARD ST APT 1203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5748
Practice Address - Country:US
Practice Address - Phone:810-300-4688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty