Organization
GREAT LAKES ANESTHESIA, P.C.
Active
Organization
GREAT LAKES ANESTHESIA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SETH CLAXTON CRNA (CEO)
(574) 522-9922
Entity
Organization
Contact information
Practice address
700 E BEARDSLEY AVE STE 209, ELKHART, IN 46514-3371
(574) 522-9922
(574) 522-9926
Mailing address
PO BOX 2147, ELKHART, IN 46515-2147
(574) 522-9922
(574) 522-9926
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200250870
—
IN
Enumeration date
05/12/2006
Last updated
11/06/2024
Update your record
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