Provider Demographics
NPI:1558328054
Name:ASSOCIATED ANESTHESIOLOGISTS MEDICAL GROUP A PROFESSIONAL CORP
Entity type:Organization
Organization Name:ASSOCIATED ANESTHESIOLOGISTS MEDICAL GROUP A PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAMPEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-323-0617
Mailing Address - Street 1:2237 ALMA STREET
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3905
Mailing Address - Country:US
Mailing Address - Phone:650-323-0617
Mailing Address - Fax:650-323-4229
Practice Address - Street 1:2237 ALMA STREET
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3905
Practice Address - Country:US
Practice Address - Phone:650-323-0617
Practice Address - Fax:650-323-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ34560Z207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ34560ZMedicare ID - Type Unspecified