Basic Information
| Provider Information | |||||||||
| NPI: | 1609130228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METRO MILWAUKEE ANESTHESIA ASSOCIATES SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21120 WASHINGTON PKWY | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604233112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154628470 | ||||||||
| FaxNumber: | 8154628471 | ||||||||
| Practice Location | |||||||||
| Address1: | 17495 W CAPITOL DR | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530452059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147610981 | ||||||||
| FaxNumber: | 4147611614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2012 | ||||||||
| LastUpdateDate: | 06/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | BORVAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8154628470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.