Healthcare Provider Details

I. General information

NPI: 1689445959
Provider Name (Legal Business Name): PRESTIGE ANESTHESIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 FASHION SQUARE BLVD STE 200
SAGINAW MI
48603-1251
US

IV. Provider business mailing address

4450 FASHION SQUARE BLVD STE 500
SAGINAW MI
48603-1251
US

V. Phone/Fax

Practice location:
  • Phone: 989-790-7950
  • Fax:
Mailing address:
  • Phone: 989-558-0734
  • Fax: 989-249-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW EAGLESON
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 989-792-4090