Organization Name: | AESTHETIC ANESTHESIA, LLC |
NPI Number: | 1023207909 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KARA G. CLARK (OWNER) |
Mailing Address: | 1912 Palmgren Dr Glenview |
State: | IL US |
Postal Code: | 600254216 |
Phone Number: | 8472699086 |
Fax Number: | |
NPI Enumeration Date: | 10/17/2007 |
NPI Last Update Date: | 06/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | 041274227 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |