MEDICARE: DETROIT ANESTHESIA GROUP PLLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1316212988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DETROIT ANESTHESIA GROUP PLLC

Provider Business Mailing Address
First Line	:	43422 W OAK DR
Second Line	:	#332
City	:	NOVI
State	:	MICHIGAN
Zip	:	48377
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	43422 W OAKS DR
Second Line	:	#332
City	:	NOVI
State	:	MI
Zip	:	48377-3300
Country	:	US
Telephone Number	:	248-378-4100
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. CHRIS YOUST
Credential	:
Telephone Number	:	248-470-9986

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	01/20/2016

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