Provider Demographics
NPI:1700434149
Name:ADVANTAGE ANESTHESIA P.C.
Entity Type:Organization
Organization Name:ADVANTAGE ANESTHESIA P.C.
Other - Org Name:ADVANTAGE ANESTHESIA P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE ANESTHESIOLOGY
Authorized Official - Phone:331-575-6121
Mailing Address - Street 1:1056 SUFFOLK CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5605
Mailing Address - Country:US
Mailing Address - Phone:331-575-6121
Mailing Address - Fax:
Practice Address - Street 1:1105 W PARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2567
Practice Address - Country:US
Practice Address - Phone:331-575-6121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty