# MILLENNIUM ANESTHESIOLOGY CONSULTANTS, LLC

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

## Provider details

- **NPI number:** 1710218094
- **Authorized official:** FREDERICK WAGNER MD (PRESIDENT)
- **Authorized official phone:** (618) 391-5589

## Contact information

- **Practice address:** 6800 STATE ROUTE 162, MARYVILLE, IL 62062-8500
- **Practice address phone:** (618) 391-5589
- **Practice address fax:** (214) 301-0649
- **Mailing address:** PO BOX 616, EDWARDSVILLE, IL 62025-0616
- **Mailing address phone:** (833) 749-8324
- **Mailing address fax:** (214) 301-0649

## Taxonomy

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

## Other

- **Enumeration date:** 01/26/2010
- **Last updated:** 08/06/2024