Organization
LAKESHORE ANESTHESIA STAFFING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCUS A GARDINER CRNA (SOLE MBR)
(231) 225-5216
Entity
Organization
Contact information
Practice address
2848 NILES RD, SAINT JOSEPH, MI 49085-3352
(269) 932-4388
Mailing address
PO BOX 1296, WARSAW, IN 46581-1296
(574) 268-9640
(574) 268-0684
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
E8460D
MI
Other
Enumeration date
06/13/2016
Last updated
06/13/2016
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