Healthcare Provider Details

I. General information

NPI: 1588986046
Provider Name (Legal Business Name): WINDY CITY ANESTHESIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

IV. Provider business mailing address

21120 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

V. Phone/Fax

Practice location:
  • Phone: 815-462-8470
  • Fax:
Mailing address:
  • Phone: 815-462-8470
  • Fax: 815-462-8471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL BORVAN
Title or Position: PRESIDENT
Credential: CRNA
Phone: 815-462-8470