1396397741 NPI number — EASTERN DISTRICT ANESTHESIOLOGY PLLC

Table of content: (NPI 1396397741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396397741 NPI number — EASTERN DISTRICT ANESTHESIOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN DISTRICT ANESTHESIOLOGY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396397741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 LOCKWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48094-2637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1349 S ROCHESTER RD STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-3186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-601-0040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PELEMAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
586-337-6837

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com