Healthcare Provider Details

I. General information

NPI: 1659421048
Provider Name (Legal Business Name): PROCTOR ENT PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N SQUIRREL RD SUITE 105
AUBURN HILLS MI
48326-4600
US

IV. Provider business mailing address

2251 N SQUIRREL RD SUITE 105
AUBURN HILLS MI
48326-4600
US

V. Phone/Fax

Practice location:
  • Phone: 248-648-8100
  • Fax: 248-648-8060
Mailing address:
  • Phone: 248-648-8100
  • Fax: 248-648-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberTP054694
License Number StateMI

VIII. Authorized Official

Name: DR. TODD B PROCTOR
Title or Position: MANAGER
Credential: M.D.
Phone: 248-648-8100