Healthcare Provider Details

I. General information

NPI: 1447514377
Provider Name (Legal Business Name): WINDY CITY ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MEDICAL DR
WENTZVILLE MO
63385-3824
US

IV. Provider business mailing address

21120 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

V. Phone/Fax

Practice location:
  • Phone: 636-327-3100
  • Fax: 815-462-8471
Mailing address:
  • Phone: 815-462-8470
  • Fax: 815-462-8471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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