Organization
AHP OF ILLINOIS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY WACHOWIAK (MANAGER/PRES)
(770) 945-5330
Entity
Organization
Contact information
Practice address
2100 MADISON AVE, GRANITE CITY, IL 62040-4701
(618) 798-3000
Mailing address
PO BOX 116935, ATLANTA, GA 30368-0001
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
08/16/2012
Last updated
08/16/2012
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