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Organization

GREAT LAKES ANESTHESIA, PLC

Active
Other names
Anesthesia Services Associates, PC
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SAMIR FULEIHAN MD (AUTHORIZED REPRESENTATIVE)
(517) 787-7438
Entity
Organization

Contact information

Practice address
1221 PINE GROVE, PORT HURON, MI 48060
(810) 989-3207
Mailing address
255 W MICHIGAN AVE, PO BOX 1123, JACKSON, MI 49201-2218
(800) 242-1131
(517) 787-4146

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary

Other

Enumeration date
08/19/2008
Last updated
08/19/2008
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