Provider Demographics
NPI:1932248622
Name:WINDY CITY ANESTHESIA PC
Entity Type:Organization
Organization Name:WINDY CITY ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BORVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-462-8470
Mailing Address - Street 1:21120 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3112
Mailing Address - Country:US
Mailing Address - Phone:815-462-8470
Mailing Address - Fax:815-462-8471
Practice Address - Street 1:21120 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3112
Practice Address - Country:US
Practice Address - Phone:815-462-8470
Practice Address - Fax:815-462-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE38195OtherBCBS NEBRASKA
IL0009932097OtherBLUE CROSS BLUE SHIELD
NE10025782800Medicaid
NE38129OtherBCBS NEBRASKA
IL606932800OtherDEPT OF LABOR WORKMEN COM
NE38195OtherBCBS NEBRASKA
IL0009932097OtherBLUE CROSS BLUE SHIELD
INM1000075473Medicare PIN