Provider Demographics
NPI:1457749509
Name:MOBILE OFFICE-BASED ANESTHESIA OF WESTERN NEW YORK PLLC
Entity Type:Organization
Organization Name:MOBILE OFFICE-BASED ANESTHESIA OF WESTERN NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-756-5760
Mailing Address - Street 1:8420 W BRYN MAWR AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3479
Mailing Address - Country:US
Mailing Address - Phone:773-756-5760
Mailing Address - Fax:773-714-1229
Practice Address - Street 1:8420 W BRYN MAWR AVE
Practice Address - Street 2:STE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3479
Practice Address - Country:US
Practice Address - Phone:773-756-5760
Practice Address - Fax:773-714-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty