Healthcare Provider Details

I. General information

NPI: 1558381392
Provider Name (Legal Business Name): WOLVERINE ANESTHESIA CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 KUHL AVE
ORLANDO FL
32806-2008
US

IV. Provider business mailing address

7111 FAIRWAY DR SUITE 450
PALM BEACH GARDENS FL
33418-4204
US

V. Phone/Fax

Practice location:
  • Phone: 561-799-3552
  • Fax:
Mailing address:
  • Phone: 561-799-3552
  • Fax: 865-291-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name: JEFFREY WEISS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-799-3552