Basic Information
| Provider Information | |||||||||
| NPI: | 1558328054 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED ANESTHESIOLOGISTS MEDICAL GROUP A PROFESSIONAL CORP | ||||||||
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| OtherOrganizationName: | ASSOCIATED ANESTHESIOLOGISTS MEDICAL GROUP, P.C. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2237 ALMA STREET | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943013905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503230617 | ||||||||
| FaxNumber: | 6503234229 | ||||||||
| Practice Location | |||||||||
| Address1: | 2237 ALMA STREET | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943013905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503230617 | ||||||||
| FaxNumber: | 6503234229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHAMPEAU | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6503230617 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ZZZ34560Z | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.