Healthcare Provider Details

I. General information

NPI: 1568907483
Provider Name (Legal Business Name): JAMES SAFRITHIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2017
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HOMER ST
MICHIGAN CITY IN
46360-4358
US

IV. Provider business mailing address

1403 EISENHOWER AVE APT 203
VALPARAISO IN
46383-0013
US

V. Phone/Fax

Practice location:
  • Phone: 219-879-8511
  • Fax:
Mailing address:
  • Phone: 312-342-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28226016A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209015493
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: