Individual
MATTHEW FARCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
30 WOODLAKE BLVD, 1304, GURNEE, IL 60031-6714
(815) 791-6084
Mailing address
1666 KIRSTEN LEE DR, WILMINGTON, IL 60481-4100
(815) 791-6084
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041382727
IL
163W00000X
Registered Nurse
193394
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
209.012934
IL
Other
Enumeration date
04/17/2015
Last updated
08/14/2015
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