# ELITE ANESTHESIA PROVIDERS, LTD

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

## Provider details

- **NPI number:** 1679258388
- **Authorized official:** MARK TOMCZAK CRNA (PRESIDENT)
- **Authorized official phone:** (708) 431-0160

## Contact information

- **Practice address:** 19110 DARVIN DR STE A, MOKENA, IL 60448-8683
- **Practice address phone:** (708) 478-8889
- **Practice address fax:** (708) 478-8507
- **Mailing address:** PO BOX 70, LAKE FOREST, IL 60045-0070
- **Mailing address phone:** (800) 444-6110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 06/20/2023
- **Last updated:** 06/20/2023