Healthcare Provider Details

I. General information

NPI: 1568534063
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF WEST MICHIGAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N ATKINSON DR
LUDINGTON MI
49431-1906
US

IV. Provider business mailing address

PO BOX 960
LUDINGTON MI
49431-0960
US

V. Phone/Fax

Practice location:
  • Phone: 231-845-2348
  • Fax: 231-845-3648
Mailing address:
  • Phone: 231-480-4668
  • Fax: 231-480-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W GREENSLAIT
Title or Position: OWNER
Credential: DO
Phone: 231-845-2348