Organization
FORERUNNER ANESTHESIA LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARISTEIDIE M DIVERIS MD (PRESIDENT)
(847) 309-9896
Entity
Organization
Contact information
Practice address
8900 BROADWAY, SUITE 100W, MERRILLVILLE, IN 46410-7040
(847) 309-9896
Mailing address
825 N SHERIDAN RD, LAKE FOREST, IL 60045-2226
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
05/27/2013
Last updated
05/28/2013
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