Provider Demographics
NPI:1306067442
Name:WATER TOWER ANESTHESIA
Entity type:Organization
Organization Name:WATER TOWER ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-944-2929
Mailing Address - Street 1:845 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 948W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2252
Mailing Address - Country:US
Mailing Address - Phone:312-944-2929
Mailing Address - Fax:312-867-7841
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:SUITE 948W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-944-2929
Practice Address - Fax:312-867-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
IL207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty