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NPI Code Detail

MEDICARE: PHYSICIAN ANESTHESIA SERVICE PC

MEDICARE: PHYSICIAN ANESTHESIA SERVICE 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
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1891780417
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN ANESTHESIA SERVICE PC
Provider Business Mailing Address
First Line : DEPT 78178 PO BOX 78000
Second Line :
City : DETROIT
State : MI
Zip : 48278-0178
Country : US
Telephone Number : 800-891-2351
Fax Number : 800-891-2351
Provider Business Practice Location Address
First Line : 826 W KING ST
Second Line :
City : OWOSSO
State : MI
Zip : 48867-2120
Country : US
Telephone Number : 989-723-5211
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MR. MARK COOK
Credential : MD
Telephone Number : 800-891-2351
Provider Enumeration Date : 09/20/2005
Last Update Date : 08/19/2020

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Directions to “PHYSICIAN ANESTHESIA SERVICE PC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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