Healthcare Provider Details

I. General information

NPI: 1023572781
Provider Name (Legal Business Name): ALLIED ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53990 CARMICHAEL DR STE 100
SOUTH BEND IN
46635-1585
US

IV. Provider business mailing address

53990 CARMICHAEL DR STE 100
SOUTH BEND IN
46635-1585
US

V. Phone/Fax

Practice location:
  • Phone: 574-807-8667
  • Fax: 574-247-3300
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MARTIN STRASSER
Title or Position: EXECUTIVE DIRECTOR
Credential: CRNA
Phone: 574-807-8667