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General NPI Number Information
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NPI Number | 1093099939
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Entity Type | Organization
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Legal Business Name | PRO MED ANESTHESIA SERVICES PLLC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 7091 ORCHARD LAKE RD STE 200
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3654
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Country | US
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Telephone | 248-444-6035
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Fax |
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Provider Business Mailing Address
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Address Line | 7091 ORCHARD LAKE RD STE 200
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3654
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Country | US
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Telephone | 248-444-6035
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J MICHAEL JR.
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Credential | M.D
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Telephone | 248-444-6035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301064575
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License Number State | MI
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