Organization
GREAT LAKES ANESTHESIA INDIANA AND MICHIGAN, PLLC
Active
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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