Basic Information
| Provider Information | |||||||||
| NPI: | 1982084497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA SURGICAL ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18100 OAKWOOD BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342123097 | ||||||||
| FaxNumber: | 7342123114 | ||||||||
| Practice Location | |||||||||
| Address1: | 34025 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480353737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342123097 | ||||||||
| FaxNumber: | 7342123114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2015 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | BORREGO | ||||||||
| AuthorizedOfficialFirstName: | RICARDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7342123097 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | E64971 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | E64971 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.