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Organization
MIDSTATE ANESTHESIOLOGISTS, LTD
Active
Organization
MIDSTATE ANESTHESIOLOGISTS, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL MACAGBA M.D (AUTHORISED REPRESENTATIVE)
(815) 937-2375
Entity
Organization
Contact information
Practice address
500 W COURT ST, KANKAKEE, IL 60901-3661
(815) 937-2375
Mailing address
255 W MICHIGAN AVE, JACKSON, MI 49201-2218
(517) 787-6440
(517) 787-4146
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
06/10/2006
Last updated
09/19/2007
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