Provider Demographics
NPI:1295773851
Name:TWIN LAKES ANESTHESIA
Entity type:Organization
Organization Name:TWIN LAKES ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-876-7301
Mailing Address - Street 1:320 PETRIE RD
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8734
Mailing Address - Country:US
Mailing Address - Phone:231-775-3026
Mailing Address - Fax:231-876-7310
Practice Address - Street 1:400 HOBART ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2331
Practice Address - Country:US
Practice Address - Phone:231-876-7301
Practice Address - Fax:231-876-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H31013OtherBLUE CROSS BLUE SHIELD
MI125997OtherPREFERRED CHOICES GROUP #
MI0M91270Medicare ID - Type Unspecified