Provider Demographics
NPI:1184987570
Name:UNIVERSITY ANESTHESIA SERVICES LLC
Entity type:Organization
Organization Name:UNIVERSITY ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-581-5943
Mailing Address - Street 1:44555 WOODWARD AVE STE 308
Mailing Address - Street 2:ST. JOSEPH MERCY OAKLAND-ANESTHESIOLOGY
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-858-3023
Mailing Address - Fax:248-858-3022
Practice Address - Street 1:44555 WOODWARD AVE STE 308
Practice Address - Street 2:ST. JOSEPH MERCY OAKLAND-ANESTHESIOLOGY
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-858-3023
Practice Address - Fax:248-858-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103253207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty