Provider Demographics
NPI:1881705937
Name:OAK BROOK ANESTHESIOLOGISTS, LTD.
Entity type:Organization
Organization Name:OAK BROOK ANESTHESIOLOGISTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIANOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-990-7770
Mailing Address - Street 1:2425 W 22ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4642
Mailing Address - Country:US
Mailing Address - Phone:630-990-2212
Mailing Address - Fax:630-990-3130
Practice Address - Street 1:2425 W 22ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4642
Practice Address - Country:US
Practice Address - Phone:630-990-2212
Practice Address - Fax:630-990-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371160Medicare UPIN