=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457745150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRATEGY ANESTHESIA MICHIGAN PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2015
-----------------------------------------------------
Last Update Date | 05/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13460 FORT ST
-----------------------------------------------------
City | SOUTHGATE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48195-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-665-3046
-----------------------------------------------------
Fax | 703-991-7269
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 758648
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21275-8648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-665-3046
-----------------------------------------------------
Fax | 703-991-7269
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KASHIF IRFAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 703-665-3046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------