Provider Demographics
NPI:1760420442
Name:GROSSE POINTE ANESTHESIOLOGISTS, PC
Entity Type:Organization
Organization Name:GROSSE POINTE ANESTHESIOLOGISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-343-1554
Mailing Address - Street 1:468 CADIEUX RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1507
Mailing Address - Country:US
Mailing Address - Phone:313-343-1554
Mailing Address - Fax:
Practice Address - Street 1:65 LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3765
Practice Address - Country:US
Practice Address - Phone:313-343-1554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4483978OtherAETNA
MI0E06034Medicare ID - Type Unspecified
MI4483978OtherAETNA
MICA8005Medicare ID - Type UnspecifiedRAILROAD MEDICARE