Healthcare Provider Details

I. General information

NPI: 1215026281
Provider Name (Legal Business Name): SJMHS ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BYRON RD
HOWELL MI
48843-1002
US

IV. Provider business mailing address

5301 MCAULEY DR (POB 992, ANN ARBOR, MI 48106)
YPSILANTI MI
48197-1051
US

V. Phone/Fax

Practice location:
  • Phone: 517-545-6000
  • 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: GARRY FAJA
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 734-712-3791