Healthcare Provider Details

I. General information

NPI: 1356884159
Provider Name (Legal Business Name): MICHAEL CHINNECK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PEELER ST
KALAMAZOO MI
49008-2300
US

IV. Provider business mailing address

900 PEELER ST
KALAMAZOO MI
49008-2300
US

V. Phone/Fax

Practice location:
  • Phone: 269-345-8618
  • Fax:
Mailing address:
  • Phone: 269-345-8618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704289695
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28276094A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number227721
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704289695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: