Provider Demographics
NPI:1962416396
Name:LINDENHURST ANESTHESIA PLLC
Entity type:Organization
Organization Name:LINDENHURST ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-756-5760
Mailing Address - Street 1:8420 W BRYN MAWR AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3479
Mailing Address - Country:US
Mailing Address - Phone:773-756-5748
Mailing Address - Fax:773-714-1351
Practice Address - Street 1:8420 W BRYN MAWR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3436
Practice Address - Country:US
Practice Address - Phone:773-355-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932089OtherBCBS
IL202815Medicare PIN
IL215044Medicare PIN
IL215045Medicare PIN