Provider Demographics
NPI:1508054966
Name:NOVI ORTHOPEDIC ANESTHESIA SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:NOVI ORTHOPEDIC ANESTHESIA SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-853-8989
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:800-853-8989
Mailing Address - Fax:
Practice Address - Street 1:48201 GRAND RIVER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1242
Practice Address - Country:US
Practice Address - Phone:800-853-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty