# CHAMPLAIN VALLEY ANESTHESIA, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902100928
- **Authorized official:** KEVIN L. IANNI MD (AUTHORIZED REPRESENTATIVE)
- **Authorized official phone:** (802) 462-3225

## Contact information

- **Practice address:** 115 PORTER DR, MIDDLEBURY, VT 05753-8423
- **Practice address phone:** (802) 388-4724
- **Mailing address:** 255 W MICHIGAN AVE, P.O. BOX 1123, JACKSON, MI 49201-2218
- **Mailing address phone:** (517) 787-6440
- **Mailing address fax:** (517) 787-4146

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/05/2011
- **Last updated:** 01/05/2011