Organization
ANESTHESIA INTENSIVE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRA BLACK D.O. (OWNER)
(563) 324-8160
Entity
Organization
Contact information
Practice address
1227 E RUSHOLME ST, DAVENPORT, IA 52803-2459
(563) 421-1000
Mailing address
PO BOX 2490, DAVENPORT, IA 52809-2490
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
06/30/2017
Last updated
06/30/2017
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