Healthcare Provider Details

I. General information

NPI: 1023067600
Provider Name (Legal Business Name): SUNRISE ANESTHESIOLOGY OF MICHIGAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S ROCHESTER RD
ROCHESTER HILLS MI
48307-4547
US

IV. Provider business mailing address

7 W SQUARE LAKE RD
BLOOMFIELD HILLS MI
48302-0462
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-3800
  • Fax:
Mailing address:
  • Phone: 586-573-5267
  • 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: HORACIO G. LARDO
Title or Position: PRESIDENT
Credential: MD
Phone: 586-573-5267