Basic Information
| Provider Information | |||||||||
| NPI: | 1184839839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHIGAN GULF TO BAY ANESTHESIOLOGY ASSOCIATES PSC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MICHIGAN GULF TO BAY ANESTHESIOLOGY ASSOCIATES PC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 COLUMBIA DR | ||||||||
| Address2: | SUITE A327 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138444396 | ||||||||
| FaxNumber: | 8138444972 | ||||||||
| Practice Location | |||||||||
| Address1: | 1375 S LAPEER RD | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | LAKE ORION | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483601421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486937954 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | MANGAR | ||||||||
| AuthorizedOfficialFirstName: | DEVANAND | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8138444396 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.