Healthcare Provider Details

I. General information

NPI: 1033152376
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES AT FOOTE HOSPITAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

205 N EAST AVE
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4963
  • Fax: 517-789-5903
Mailing address:
  • Phone: 517-788-4963
  • Fax: 517-789-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BARRY PLATT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 517-788-4963