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General NPI Number Information
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NPI Number | 1831613587
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Entity Type | Individual
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Provider Name | MAXWELL EDEM DOGBATSE CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 36475 FIVE MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-1971
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Country | US
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Telephone | 734-655-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 44717 FENWICK DR
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City | CANTON
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State | MI
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Zip | 48188-3245
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Country | US
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Telephone | 313-633-4499
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704292537
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License Number State | MI
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