Healthcare Provider Details

I. General information

NPI: 1205325255
Provider Name (Legal Business Name): MICHAEL ANTHONY TONELLI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2018
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W UNIVERSITY DR STE 100
ROCHESTER MI
48307-1874
US

IV. Provider business mailing address

2307 GYSIN CT
BAY CITY MI
48708-6848
US

V. Phone/Fax

Practice location:
  • Phone: 248-402-0266
  • Fax:
Mailing address:
  • Phone: 586-904-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704289502
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: