Healthcare Provider Details

I. General information

NPI: 1720103112
Provider Name (Legal Business Name): UNIVERSITY OTOLARYNGOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43494 WOODWARD AVE SUITE 210
BLOOMFIELD TOWNSHIP MI
48302-5052
US

IV. Provider business mailing address

3800 WOODWARD AVE SUITE 600
DETROIT MI
48201-2061
US

V. Phone/Fax

Practice location:
  • Phone: 248-335-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: SHARON BRANKA
Title or Position: COORDINATOR
Credential:
Phone: 313-745-1740