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General NPI Number Information
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NPI Number | 1033340898
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Entity Type | Organization
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Legal Business Name | PREFERRED ANESTHESIA ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 800 LINCOLNWAY SUITE 301
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City | LA PORTE
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State | IN
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Zip | 46350-3438
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Country | US
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Telephone | 219-324-2229
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Fax | 219-324-2229
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Provider Business Mailing Address
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Address Line | 800 LINCOLNWAY SUITE 301
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City | LA PORTE
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State | IN
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Zip | 46350-3438
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Country | US
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Telephone | 219-324-2229
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Fax | 219-324-2229
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOMMY MISLENKOV
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Credential | MD
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Telephone | 219-324-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01061306A
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License Number State | IN
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