Organization
MID-AMERICAN ANESTHESIA AND PAIN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERYL L GONION RHIT (CREDENTIALING)
(847) 615-2200
Entity
Organization
Contact information
Practice address
4500 UTICA RIDGE RD, BETTENDORF, IA 52722-1626
(563) 742-5000
(847) 615-2858
Mailing address
PO BOX 689, LAKE FOREST, IL 60045-0689
(847) 615-2200
(847) 615-2858
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
34558
IA
208VP0014X
Interventional Pain Medicine Physician
34558
IA
Other
Enumeration date
02/01/2013
Last updated
02/01/2013
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