Organization
POLYKARPOS ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARISTEIDIE DIVERIS MD (AUTHORIZED OFFICIAL)
(847) 309-9896
Entity
Organization
Contact information
Practice address
8400 LAKEVIEW PKWY STE 800, PLEASANT PRAIRIE, WI 53158-5819
(705) 275-7799
Mailing address
825 N SHERIDAN RD, LAKE FOREST, IL 60045-2226
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
06/06/2017
Last updated
06/06/2017
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