Healthcare Provider Details

I. General information

NPI: 1396397741
Provider Name (Legal Business Name): EASTERN DISTRICT ANESTHESIOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S ROCHESTER RD STE 250
ROCHESTER HILLS MI
48307-3186
US

IV. Provider business mailing address

5600 LOCKWOOD DR
WASHINGTON MI
48094-2637
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-0040
  • Fax:
Mailing address:
  • Phone:
  • 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: ROBERT GINNEBAUGH
Title or Position: PRESIDENT
Credential: MD
Phone: 586-263-2373