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General NPI Number Information
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NPI Number | 1386976090
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Entity Type | Organization
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Legal Business Name | MICHIGAN ANESTHESIA CARE ONE PC
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 13601 PRESTON RD #1000W
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 972-715-5682
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Fax | 972-715-5682
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Provider Business Mailing Address
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Address Line | 5565 CENTERVIEW DR STE 107
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City | RALEIGH
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State | NC
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Zip | 27606-3563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHY KONDAS
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Credential |
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Telephone | 973-251-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #6
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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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