Healthcare Provider Details

I. General information

NPI: 1750508214
Provider Name (Legal Business Name): JOEL CHARLES GARCIA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

8098 WINONA AVE
ALLEN PARK MI
48101-2228
US

V. Phone/Fax

Practice location:
  • Phone: 734-263-2417
  • Fax:
Mailing address:
  • Phone: 313-382-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704234457
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: