Individual
MR. WALTER LAESCH
Active
Individual
MR. WALTER LAESCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209-000371
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09223524
BC/BS GROUP ID NO.
IL
01
—
216564000
WORKMAN'S COMP GROUP ID
IL
01
—
371390028001
TRICARE GROUP ID NO.
IL
01
—
430052840
RR MEDICARE GROUP ID NO.
IL
01
—
CG3273
RR MEDICARE GROUP ID NO.
IL
Enumeration date
11/21/2005
Last updated
10/05/2011
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