Healthcare Provider Details

I. General information

NPI: 1952350555
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N MACOMB ST
MONROE MI
48162-7815
US

IV. Provider business mailing address

PO BOX 1904 SUITE 100
MONROE MI
48161-6904
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-8400
  • Fax:
Mailing address:
  • Phone: 313-580-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAUFIEK ALHADI
Title or Position: OWNER
Credential: DO
Phone: 313-580-9501