MEDICARE: ROGER W ZANDER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	4704118315	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RZ118315	OTHER	MI	BLUE CROSS OF MI

General Provider Information

NPI Number	:	1144236274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER W ZANDER CRNA

Provider Business Mailing Address
First Line	:	22211 MORLEY AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2110
Country	:	US
Telephone Number	:	313-492-5056
Fax Number	:	313-565-8156

Provider Business Practice Location Address
First Line	:	22211 MORLEY AVE
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2110
Country	:	US
Telephone Number	:	313-492-5056
Fax Number	:	313-565-8156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	11/15/2010

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