1932248622 NPI number — WINDY CITY ANESTHESIA PC

Table of content: (NPI 1932248622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932248622 NPI number — WINDY CITY ANESTHESIA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDY CITY ANESTHESIA PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932248622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21120 WASHINGTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60423-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-462-8470
Provider Business Mailing Address Fax Number:
815-462-8471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21120 WASHINGTON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60423-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-691-9080
Provider Business Practice Location Address Fax Number:
224-255-5813
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORVAN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
815-370-1933

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0009932097 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 606932800 . This is a "DEPT OF LABOR WORKMEN COM" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 38129 . This is a "BCBS NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 38195 . This is a "BCBS NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025782800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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