Healthcare Provider Details

I. General information

NPI: 1831231869
Provider Name (Legal Business Name): DAVID A SARACENO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

1 FORD PL
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 248-632-3010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704229257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: