Provider Demographics
NPI:1861579542
Name:GENESEE MEDICAL ANESTHESIA, PC
Entity type:Organization
Organization Name:GENESEE MEDICAL ANESTHESIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-257-9284
Mailing Address - Street 1:1 HURLEY PLZ
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5902
Mailing Address - Country:US
Mailing Address - Phone:810-257-9284
Mailing Address - Fax:
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-257-9284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111512OtherCARE CHOICES/PREFERRED CH
MIAN250015OtherMCARE
MI0995237OtherHEALTH PLUS OF MICHIGAN
MI0995237OtherHEALTH PLUS OF MICHIGAN
MICI3176Medicare ID - Type UnspecifiedRAILROAD