MEDICARE: MR. WILLIAM DEANS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist		IL

General Provider Information

NPI Number	:	1639174717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM DEANS CRNA

Provider Business Mailing Address
First Line	:	5644 N KILBOURN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5912
Country	:	US
Telephone Number	:	773-202-9104
Fax Number	:	773-202-9105

Provider Business Practice Location Address
First Line	:	9600 GROSS POINT RD
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1214
Country	:	US
Telephone Number	:	847-933-6909
Fax Number	:	847-933-3829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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