Healthcare Provider Details

I. General information

NPI: 1235181223
Provider Name (Legal Business Name): AMERICAN ANESTHESIOLOGY ASSOCIATES OF MICHIGAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GENESYS PKWY
GRAND BLANC MI
48439-8065
US

IV. Provider business mailing address

2432 GENESYS PKWY
GRAND BLANC MI
48439-8069
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-6499
  • Fax: 810-606-7245
Mailing address:
  • Phone: 810-606-6499
  • Fax: 810-606-7245

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: GREGG L BRENT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 810-606-6499