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NPI Code Detail

MEDICARE: GARY L PINEAU CRNA

MEDICARE:   GARY L PINEAU  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
1367500000XCertified Registered Nurse Anesthetist4704101385MI

General Provider Information

NPI Number : 1447292628
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY L PINEAU CRNA
Provider Business Mailing Address
First Line : 255 W MICHIGAN AVE
Second Line :
City : JACKSON
State : MI
Zip : 49201-2218
Country : US
Telephone Number : 517-787-6440
Fax Number : 517-787-4146
Provider Business Practice Location Address
First Line : 27351 DEQUINDRE RD
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-3487
Country : US
Telephone Number : 810-753-0185
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 07/08/2007

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