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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
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