Healthcare Provider Details

I. General information

NPI: 1609130228
Provider Name (Legal Business Name): METRO MILWAUKEE ANESTHESIA ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17495 W CAPITOL DR
BROOKFIELD WI
53045-2059
US

IV. Provider business mailing address

21120 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

V. Phone/Fax

Practice location:
  • Phone: 847-691-9080
  • Fax: 224-255-5813
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: 815-370-1933