Healthcare Provider Details

I. General information

NPI: 1962661876
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF NORTHERN INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E MAUMEE ST
ANGOLA IN
46703-2015
US

IV. Provider business mailing address

2914 S REPUBLIC BLVD
TOLEDO OH
43615-1912
US

V. Phone/Fax

Practice location:
  • Phone: 419-531-8808
  • Fax: 419-531-8877
Mailing address:
  • Phone: 419-531-8808
  • Fax: 419-531-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KARYN KOVACH
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 419-531-8808