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General NPI Number Information
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NPI Number | 1720329220
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Entity Type | Organization
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Legal Business Name | DHOM ANESTHESIA ADMINISTRATIVE SERVICES LLC
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 461 W HURON ST
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City | PONTIAC
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State | MI
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Zip | 48341-1601
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Country | US
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Telephone | 248-857-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 WOODSIDE DR
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City | FLINT
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State | MI
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Zip | 48503-5341
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Country | US
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Telephone | 810-869-0397
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA JOSEPH
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Credential | MD
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Telephone | 810-869-0397
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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 | 4301061430
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License Number State | MI
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