MEDICARE: ANESTHESIA ASSOCIATES OF ANN ARBOR, PLLC

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		MI
2	207L00000X	Anesthesiology Physician		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0H11388	OTHER	MI	BCBS
2	0H17604	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1669581997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA ASSOCIATES OF ANN ARBOR, PLLC

Provider Business Mailing Address
First Line	:	2006 HOGBACK RD STE 5A
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9750
Country	:	US
Telephone Number	:	734-263-2395
Fax Number	:	734-773-3471

Provider Business Practice Location Address
First Line	:	33545 CHERRY HILL RD FL 2
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48186-4842
Country	:	US
Telephone Number	:	313-293-7777
Fax Number	:

Authorized Official
Title or Position	:	CHAIR
Name	:	TRACI COFFMAN
Credential	:	MD
Telephone Number	:	734-263-2400

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/25/2025

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