Provider Demographics
NPI:1598124794
Name:MDAS OF WEST MICHIGAN
Entity Type:Organization
Organization Name:MDAS OF WEST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUST
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:248-470-9986
Mailing Address - Street 1:43422 W OAKS DR
Mailing Address - Street 2:STE 332
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43422 W OAKS DR
Practice Address - Street 2:STE 332
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3300
Practice Address - Country:US
Practice Address - Phone:248-378-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty