Healthcare Provider Details

I. General information

NPI: 1588938971
Provider Name (Legal Business Name): SUMMIT ANESTHESIA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

1225 E LATHAM AVE SUITE A
HEMET CA
92543-4423
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-8700
  • Fax: 951-766-9944
Mailing address:
  • Phone: 951-652-8700
  • Fax: 951-766-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KALI P CHAUDHURI
Title or Position: PRESIDENT
Credential: MD
Phone: 951-652-8700