Great Lakes Anesthesia Consultants PLLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

GREAT LAKES ANESTHESIA CONSULTANTS PLLC

Practice address

7901 Angling Rd
Portage, MI 49024-0714

Phone

(269) 324-8406

NPI assigned

Mar 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brij M. Dewan, MD

Title

Member

Phone

(269) 324-8406

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1609142447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19",
            "city": "NAZARETH",
            "state": "MI",
            "postal_code": "490740019",
            "telephone_number": "941-360-1566",
            "fax_number": "941-358-9818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 ANGLING RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240714",
            "telephone_number": "269-324-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES ANESTHESIA CONSULTANTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-27",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "DEWAN",
        "authorized_official_first_name": "BRIJ",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "269-324-8406",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in Portage, MI
• Providers in Portage, MI by specialty
• Anesthesiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.