Provider Demographics
NPI:1043451651
Name:GLENDALE ANESTHESIA PROVIDERS SC
Entity Type:Organization
Organization Name:GLENDALE ANESTHESIA PROVIDERS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STETZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-365-3210
Mailing Address - Street 1:4555 W SCHROEDER DR
Mailing Address - Street 2:#170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1475
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:7007 N RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-2620
Practice Address - Country:US
Practice Address - Phone:414-352-3341
Practice Address - Fax:414-247-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty