Healthcare Provider Details

I. General information

NPI: 1295773851
Provider Name (Legal Business Name): TWIN LAKES ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOBART ST
CADILLAC MI
49601-2331
US

IV. Provider business mailing address

320 PETRIE RD
CADILLAC MI
49601-8734
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-7301
  • Fax: 231-876-7310
Mailing address:
  • Phone: 231-775-3026
  • Fax: 231-876-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIZABETH ADAMSON
Title or Position: OFFICER
Credential: M.D.
Phone: 231-876-7301