Healthcare Provider Details

I. General information

NPI: 1114181518
Provider Name (Legal Business Name): WSA ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

PO BOX 486
LAKE FOREST IL
60045-0486
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-3029
  • Fax:
Mailing address:
  • Phone: 847-433-1539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD SCHECHTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-433-1539