MEDICARE: MG ANESTHESIA, LLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1942647219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MG ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	17501 GENERATIONS DR
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1589
Country	:	US
Telephone Number	:	574-234-0049
Fax Number	:	574-234-0053

Provider Business Practice Location Address
First Line	:	53830 GENERATIONS DR
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1557
Country	:	US
Telephone Number	:	574-271-0893
Fax Number	:	574-234-0053

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PANKAJ A PATEL
Credential	:	MD
Telephone Number	:	574-234-0049

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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Directions to “MG ANESTHESIA, LLC ” Practice Location

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