Organization
LAKE ANESTHESIA ASSOCIATES
Active
Organization
LAKE ANESTHESIA ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS J AFRICANO CRNA (OWNER)
(708) 798-5838
Entity
Organization
Contact information
Practice address
19624 GOVERNORS HWY, FLOSSMOOR, IL 60422-2077
(708) 798-5838
Mailing address
PO BOX 158, FLOSSMOOR, IL 60422-0158
(708) 798-5838
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008253495
AETNA PIN
IL
01
—
DG3846
PALMETTO GBA/ RR MEDICARE
IL
Enumeration date
06/01/2007
Last updated
01/09/2008
Update your record
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