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General NPI Number Information
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NPI Number | 1194812651
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Entity Type | Organization
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Legal Business Name | LONG LAKE ANESTHESIOLOGY CONSULTANTS, PLC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 4550 INVESTMENT DR SUITE 100
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City | TROY
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State | MI
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Zip | 48098-6363
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Country | US
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Telephone | 800-581-9044
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Fax | 248-856-3357
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Provider Business Mailing Address
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Address Line | 4550 INVESTMENT DR SUITE 100
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City | TROY
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State | MI
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Zip | 48098-6363
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Country | US
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Telephone | 800-581-9044
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Fax | 248-856-3357
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DONALD SIWEK
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Credential | M.D.
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Telephone | 248-835-9829
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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 |
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License Number State |
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