MEDICARE: NORTHCOAST ANESTHESIA PROVIDERS

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	207LC0200X	Critical Care Medicine (Anesthesiology) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG9622	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982697116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHCOAST ANESTHESIA PROVIDERS

Provider Business Mailing Address
First Line	:	255 W MICHIGAN AVE
Second Line	:	PO BOX 1123
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	:	29000 CENTER RIDGE RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-5293
Country	:	US
Telephone Number	:	440-827-5000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ROBERT J PUJOLAS
Credential	:	DO
Telephone Number	:	440-708-0102

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	04/23/2009

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Directions to “NORTHCOAST ANESTHESIA PROVIDERS ” Practice Location

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