Healthcare Provider Details

I. General information

NPI: 1952508582
Provider Name (Legal Business Name): ANESTHESIA AND PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE LANSING RD SUITE G06
LANSING MI
48912-3756
US

IV. Provider business mailing address

1540 LAKE LANSING RD SUITE G06
LANSING MI
48912-3756
US

V. Phone/Fax

Practice location:
  • Phone: 517-482-7246
  • Fax: 517-484-7377
Mailing address:
  • Phone: 517-482-7246
  • Fax: 517-484-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MELONI WILLIAMS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 517-482-7246