1083659932 NPI number — CENTER FOR EAR,NOSE AND THROAT PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083659932 NPI number — CENTER FOR EAR,NOSE AND THROAT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR EAR,NOSE AND THROAT PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083659932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 HAGGERTY RD STE 2130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48323-2191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-668-1104
Provider Business Mailing Address Fax Number:
248-668-1096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 HAGGERTY ROAD
Provider Second Line Business Practice Location Address:
SUITE 2130
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-668-1104
Provider Business Practice Location Address Fax Number:
248-668-1096
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
JOE
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
248-668-1104

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X , with the licence number:  5101010029 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4233036 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 040F338670 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 82908 . This is a "PHCS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: F31235 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101058 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4100372 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040015528 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0456336254 . This is a "BCBC BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: B9900 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2886 . This is a "CAPE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 040F338670 . This is a "BCBS GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1009579 . This is a "GREAT WEST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 107796 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 12043 . This is a "DMC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com