Provider Demographics
NPI:1467795013
Name:SYNERGY ANESTHESIA PLLC
Entity Type:Organization
Organization Name:SYNERGY ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-573-5261
Mailing Address - Street 1:6689 ORCHARD LAKE RD
Mailing Address - Street 2:STE 275
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3404
Mailing Address - Country:US
Mailing Address - Phone:586-573-5261
Mailing Address - Fax:586-573-5364
Practice Address - Street 1:5504 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4684
Practice Address - Country:US
Practice Address - Phone:586-838-2035
Practice Address - Fax:586-218-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty