Organization
UNIVERSITY ANESTHESIOLOGISTS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY GOODMAN M.D. (PRESIDENT)
(224) 231-4363
Entity
Organization
Contact information
Practice address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(312) 942-3135
Mailing address
PO BOX 6350, CHICAGO, IL 60680-6350
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041366223
IL
Other
Enumeration date
08/10/2015
Last updated
08/10/2015
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