Provider Demographics
NPI:1295156602
Name:WEST CENTRAL ANESTHESIOLOGY GROUP LTD.
Entity type:Organization
Organization Name:WEST CENTRAL ANESTHESIOLOGY GROUP LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-290-6309
Mailing Address - Street 1:1336 GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4212
Mailing Address - Country:US
Mailing Address - Phone:630-377-2727
Mailing Address - Fax:630-377-2727
Practice Address - Street 1:1336 GENEVA RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-4212
Practice Address - Country:US
Practice Address - Phone:630-377-2727
Practice Address - Fax:630-377-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-044476207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC44163Medicare UPIN