Provider Demographics
NPI:1184839839
Name:MICHIGAN GULF TO BAY ANESTHESIOLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:MICHIGAN GULF TO BAY ANESTHESIOLOGY ASSOCIATES PSC
Other - Org Name:MICHIGAN GULF TO BAY ANESTHESIOLOGY ASSOCIATES PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-844-4396
Mailing Address - Street 1:2 COLUMBIA DR
Mailing Address - Street 2:SUITE A327
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3508
Mailing Address - Country:US
Mailing Address - Phone:813-844-4396
Mailing Address - Fax:813-844-4972
Practice Address - Street 1:1375 S LAPEER RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1421
Practice Address - Country:US
Practice Address - Phone:248-693-7954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID