Healthcare Provider Details

I. General information

NPI: 1255415428
Provider Name (Legal Business Name): ROY MUMIN ALISOGLU CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 DIEHL RD
METAMORA MI
48455-9753
US

IV. Provider business mailing address

5380 DIEHL RD
METAMORA MI
48455-9753
US

V. Phone/Fax

Practice location:
  • Phone: 989-928-2349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704147140
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: