Provider Demographics
NPI:1396790242
Name:ANESTHESIA OFFICE CONSULTANTS, PLLC
Entity type:Organization
Organization Name:ANESTHESIA OFFICE CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORREGO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:734-765-2921
Mailing Address - Street 1:26906 PEPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4470
Mailing Address - Country:US
Mailing Address - Phone:734-765-2921
Mailing Address - Fax:
Practice Address - Street 1:18100 OAKWOOD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4071
Practice Address - Country:US
Practice Address - Phone:313-253-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7721746OtherAETNA
MIAN820029OtherMCARE
MIDC9599Medicare ID - Type UnspecifiedMEDICARE RAILROAD
MI0N83940Medicare ID - Type Unspecified