Provider Demographics
NPI:1750689121
Name:MICHIGAN CRITICAL CARE ANESTHESIOLOGY
Entity Type:Organization
Organization Name:MICHIGAN CRITICAL CARE ANESTHESIOLOGY
Other - Org Name:MICHIGAN CCA PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRASSIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DENCHEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-359-3539
Mailing Address - Street 1:8316 VIRGIL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-359-3539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty