Provider Demographics
NPI:1699944785
Name:AAOC SURGERY CENTER ANESTHESIA LLC
Entity type:Organization
Organization Name:AAOC SURGERY CENTER ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIOKEMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:312-676-0828
Mailing Address - Street 1:409 WEST HURON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-0001
Mailing Address - Country:US
Mailing Address - Phone:312-676-0828
Mailing Address - Fax:312-944-5801
Practice Address - Street 1:25 E WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1733
Practice Address - Country:US
Practice Address - Phone:312-726-3329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086579207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1639014OtherBLUE SHIELD OF ILLINOIS
IL1639014OtherBLUE SHIELD OF ILLINOIS