Healthcare Provider Details

I. General information

NPI: 1740395284
Provider Name (Legal Business Name): DANIEL W BLASZCZYK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOGBACK RD SUITE 5A
ANN ARBOR MI
48105-9750
US

IV. Provider business mailing address

2006 HOGBACK RD SUITE 5A
ANN ARBOR MI
48105-9750
US

V. Phone/Fax

Practice location:
  • Phone: 734-263-2414
  • Fax: 734-773-3471
Mailing address:
  • Phone: 734-263-2414
  • Fax: 734-773-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704196309
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: