Provider Demographics
NPI:1366098162
Name:PRINCIPAL ANESTHESIA LLC
Entity type:Organization
Organization Name:PRINCIPAL ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:AIZIGOV
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:847-615-2200
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0070
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:847-615-2858
Practice Address - Street 1:1928 45TH ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3917
Practice Address - Country:US
Practice Address - Phone:219-476-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty