Healthcare Provider Details

I. General information

NPI: 1588657183
Provider Name (Legal Business Name): MICHAEL SILKA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WELTY RD
LUCAS OH
44843-9729
US

IV. Provider business mailing address

PO BOX 1547
MANSFIELD OH
44901-1547
US

V. Phone/Fax

Practice location:
  • Phone: 419-892-5798
  • Fax: 419-892-2694
Mailing address:
  • Phone: 567-274-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN320687
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA08429
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: