MEDICARE: JAMES SCARSELLA 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	4704145880	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JS145880	OTHER	MI	BLUE CROSS OF MI

General Provider Information

NPI Number	:	1265412522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SCARSELLA CRNA

Provider Business Mailing Address
First Line	:	847 WASHINGTON RD
Second Line	:
City	:	GROSSE POINTE
State	:	MI
Zip	:	48230-1293
Country	:	US
Telephone Number	:	313-886-1962
Fax Number	:

Provider Business Practice Location Address
First Line	:	30200 TELEGRAPH RD
Second Line	:	SUITE 220
City	:	BINGHAM FARMS
State	:	MI
Zip	:	48025-4502
Country	:	US
Telephone Number	:	248-258-5058
Fax Number	:

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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