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Organization
PROFESSIONAL ANESTHESIA ASSOCIATES PC
Active
Organization
PROFESSIONAL ANESTHESIA ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIDHAT QIDWAI MD (MEDICAL DIRECTOR)
(310) 548-5161
Entity
Organization
Contact information
Practice address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 832-3311
Mailing address
PO BOX 1123, JACKSON, MI 49204-1123
(517) 787-6440
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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