Provider Demographics
NPI:1790155117
Name:MIRADOR ANESTHESIA CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:MIRADOR ANESTHESIA CONSULTANTS, PLLC
Other - Org Name:LUXE ANESTHESIA, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HAJIBASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-945-4582
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0112
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:5706 E MOCKINGBIRD LN STE 115
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5461
Practice Address - Country:US
Practice Address - Phone:214-945-4582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6406207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty