Provider Demographics
NPI:1952308223
Name:ANESTHESIA ASSOCIATES, LTD
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COULSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-748-8993
Mailing Address - Street 1:350 S NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4216
Mailing Address - Country:US
Mailing Address - Phone:847-720-7457
Mailing Address - Fax:847-720-7102
Practice Address - Street 1:2540 HANFORD LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-6969
Practice Address - Country:US
Practice Address - Phone:815-748-8993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL999999999207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206595Medicare ID - Type UnspecifiedPHYSICIANS GROUP #
IL201023Medicare ID - Type UnspecifiedCRNA GROUP NUMBER