Healthcare Provider Details

I. General information

NPI: 1770065104
Provider Name (Legal Business Name): CHASE BUEHLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2018
Last Update Date: 09/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514
US

IV. Provider business mailing address

1228 RIDGEWAY AVE
AURORA IL
60506
US

V. Phone/Fax

Practice location:
  • Phone: 630-338-3793
  • Fax:
Mailing address:
  • Phone: 630-338-3793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number714334
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: