Healthcare Provider Details

I. General information

NPI: 1578703252
Provider Name (Legal Business Name): LAKESHORE ANESTHESIA SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CLINTON ST
MUSKEGON MI
49442-5502
US

IV. Provider business mailing address

550 W WESTERN AVE STE B
MUSKEGON MI
49440-1045
US

V. Phone/Fax

Practice location:
  • Phone: 231-726-3511
  • Fax:
Mailing address:
  • Phone: 231-726-4498
  • Fax: 231-726-4468

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: PAUL M CHOVAZ
Title or Position: PRESIDENT
Credential: MD
Phone: 231-726-4498