Provider Demographics
NPI:1053583716
Name:AMBULATORY ANESTHESIOLOGY, LTD.
Entity type:Organization
Organization Name:AMBULATORY ANESTHESIOLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANZEROTTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-585-0283
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-0489
Mailing Address - Country:US
Mailing Address - Phone:309-585-0283
Mailing Address - Fax:309-585-0283
Practice Address - Street 1:3801 IRELAND GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-664-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty