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General NPI Number Information
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NPI Number | 1801854013
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Entity Type | Individual
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Provider Name | DONALD NEAL CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30200 TELEGRAPH RD SUITE 220
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-4502
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Country | US
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Telephone | 248-258-5058
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Fax |
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Provider Business Mailing Address
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Address Line | 20807 REVERE ST
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City | ST CLAIR SHORES
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State | MI
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Zip | 48080-1124
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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 |
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Name |
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Credential |
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Telephone |
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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 | 4704136409
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License Number State | MI
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