Organization
GREAT LAKES ANESTHESIA INDIANA AND MICHIGAN, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BART POWERS D.O. (OWNER/BOARD MEMBER)
(574) 522-9922
Entity
Organization
Contact information
Practice address
916 MYRTLE ST, STURGIS, MI 49091-2326
(574) 522-9922
(574) 522-9926
Mailing address
PO BOX 686, INDIANAPOLIS, IN 46206-0686
(574) 522-9922
(574) 522-9926
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G50066
ANTHEM
MI
01
—
0G50067
ANTHEM
MI
05
—
1891069605
—
MI
01
—
DS9802
RAILROAD MEDICARE
MI
Enumeration date
02/27/2012
Last updated
02/13/2013
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