Provider Demographics
NPI:1679758288
Name:MID AMERICA ANESTHESIA LLC
Entity type:Organization
Organization Name:MID AMERICA ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NARAYANARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVISHANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-926-3096
Mailing Address - Street 1:912 SAINT STEPHENS GRN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2568
Mailing Address - Country:US
Mailing Address - Phone:630-926-3096
Mailing Address - Fax:
Practice Address - Street 1:3101 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4532
Practice Address - Country:US
Practice Address - Phone:773-889-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty