Healthcare Provider Details

I. General information

NPI: 1447788534
Provider Name (Legal Business Name): GRAND ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LAFAYETTE AVE SE
GRAND RAPIDS MI
49503-4693
US

IV. Provider business mailing address

5520 LBJ FWY STE 200
DALLAS TX
75240-6381
US

V. Phone/Fax

Practice location:
  • Phone: 972-331-0707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HAROON ILYAS RASHEED
Title or Position: OWNER
Credential: MD
Phone: 972-331-0707