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Organization
GREENVILLE ANESTHESIOLOGY, PA
Active
Organization
GREENVILLE ANESTHESIOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER BOUKEDES MD (AUTHORIZED REPRESENTATIVE)
(864) 242-4602
Entity
Organization
Contact information
Practice address
1007 GROVE RD, GREENVILLE, SC 29605-4630
(864) 242-4602
Mailing address
255 W MICHIGAN AVE, JACKSON, MI 49201-2218
(517) 787-6440
(517) 787-4146
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0382
—
SC
Enumeration date
06/06/2006
Last updated
10/23/2007
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