# MIDSTATE ANESTHESIOLOGISTS, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275574998
- **Authorized official:** DR. SAMUEL MACAGBA M.D (AUTHORISED REPRESENTATIVE)
- **Authorized official phone:** (815) 937-2375

## Contact information

- **Practice address:** 500 W COURT ST, KANKAKEE, IL 60901-3661
- **Practice address phone:** (815) 937-2375
- **Mailing address:** 255 W MICHIGAN AVE, JACKSON, MI 49201-2218
- **Mailing address phone:** (517) 787-6440
- **Mailing address fax:** (517) 787-4146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/10/2006
- **Last updated:** 09/19/2007