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NPI Code Detail

MEDICARE: NORTHSTAR ANESTHESIA OF MICHIGAN II PC

MEDICARE: NORTHSTAR ANESTHESIA OF MICHIGAN II PC
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
1367500000XCertified Registered Nurse Anesthetist
2207L00000XAnesthesiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1050F319200OTHERMIBCBS

General Provider Information

NPI Number : 1437268026
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHSTAR ANESTHESIA OF MICHIGAN II PC
Provider Business Mailing Address
First Line : PO BOX 612382
Second Line :
City : DALLAS
State : TX
Zip : 75261-2382
Country : US
Telephone Number : 239-610-0775
Fax Number :
Provider Business Practice Location Address
First Line : 6225 N STATE HIGHWAY 161 STE 200
Second Line :
City : IRVING
State : TX
Zip : 75038-2241
Country : US
Telephone Number : 214-687-0001
Fax Number : 972-518-2100
Authorized Official
Title or Position : PRESIDENT
Name : DR. PHILIP W EICHENHOLZ
Credential : MD
Telephone Number : 214-687-0008
Provider Enumeration Date : 08/29/2006
Last Update Date : 05/25/2021

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