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General NPI Number Information
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NPI Number | 1922436062
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Entity Type | Organization
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Legal Business Name | SIESTA ANESTHESIA SERVICES, PLLC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 520 N 3RD AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1507
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Country | US
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Telephone | 208-263-1441
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2556
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City | SANDPOINT
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State | ID
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Zip | 83864-0917
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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 | MEMBER
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Name | MICHAEL ROSENKRANZ
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Credential | M.D.
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Telephone | 208-610-5503
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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 | M-12159
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License Number State | ID
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