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General NPI Number Information
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NPI Number | 1376862474
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Entity Type | Organization
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Legal Business Name | WATERFORD ANESTHESIA, PLLC
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 5220 HIGHLAND RD SUITE 100
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City | WATERFORD
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State | MI
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Zip | 48327-1975
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Country | US
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Telephone | 248-886-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 5220 HIGHLAND RD SUITE 100
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City | WATERFORD
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State | MI
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Zip | 48327-1975
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Country | US
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Telephone | 248-886-5555
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | BHAVANI P. GARAPATI
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Credential | MD
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Telephone | 248-886-5555
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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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