Healthcare Provider Details

I. General information

NPI: 1265417729
Provider Name (Legal Business Name): COASTAL EAR NOSE & THROAT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W GRANADA BLVD SUITE 4
ORMOND BEACH FL
32174-8154
US

IV. Provider business mailing address

1050 W GRANADA BLVD SUITE 4
ORMOND BEACH FL
32174-8154
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-8808
  • Fax: 386-677-9919
Mailing address:
  • Phone: 386-677-8808
  • Fax: 386-677-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL A MUNIER
Title or Position: PRESIDENT
Credential: MD
Phone: 386-677-8808