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General NPI Number Information
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NPI Number | 1578703252
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Entity Type | Organization
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Legal Business Name | LAKESHORE ANESTHESIA SERVICES, PC
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 1700 CLINTON ST
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City | MUSKEGON
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State | MI
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Zip | 49442-5502
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Country | US
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Telephone | 231-726-3511
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Fax |
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Provider Business Mailing Address
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Address Line | 550 W WESTERN AVE STE B
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City | MUSKEGON
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State | MI
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Zip | 49440-1045
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Country | US
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Telephone | 231-726-4498
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Fax | 231-726-4468
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL M CHOVAZ
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Credential | MD
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Telephone | 231-726-4498
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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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Taxonomy #2
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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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