MEDICARE: HDL ANESTHESIA CONSULTANTS, 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	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0H22802	OTHER	MI	BLUE SHIELD
2	0H20277	OTHER	MI	BLUE SHIELD

General Provider Information

NPI Number	:	1437101664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HDL ANESTHESIA CONSULTANTS, PLLC

Provider Business Mailing Address
First Line	:	255 W MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2218
Country	:	US
Telephone Number	:	517-787-6440
Fax Number	:	517-787-4146

Provider Business Practice Location Address
First Line	:	5452 FORT ST
Second Line	:
City	:	TRENTON
State	:	MI
Zip	:	48183-4601
Country	:	US
Telephone Number	:	800-242-1131
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED REPRESENTATIVE
Name	:	DR. ASIM DURRANI
Credential	:	MD
Telephone Number	:	313-410-1120

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	01/31/2008

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