Organization
UNITED SURGICAL ANESTHESIA LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN D. SHOULTS M.D. (PRESIDENT)
(847) 967-1149
Entity
Organization
Contact information
Practice address
450 W HIGHWAY 22, BARRINGTON, IL 60010-7509
(847) 381-9600
Mailing address
8135 N MILWAUKEE AVE, NILES, IL 60714-2828
(847) 967-1149
(847) 967-8594
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04932242
BLUE SHIELD OF ILLINOIS
IL
Enumeration date
05/26/2006
Last updated
08/22/2020
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