Healthcare Provider Details

I. General information

NPI: 1811178684
Provider Name (Legal Business Name): EAR NOSE THROAT AND PLASTIC SURGERY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 REGENCY PARK DR
GRAND BLANC MI
48439-2559
US

IV. Provider business mailing address

3455 REGENCY PARK DR
GRAND BLANC MI
48439-2559
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-0600
  • Fax: 810-694-0601
Mailing address:
  • Phone: 810-694-0600
  • Fax: 810-694-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberSM007572
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberSR014325
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberWR010496
License Number StateMI

VIII. Authorized Official

Name: DR. STEVEN C RESCHAK
Title or Position: DIRECTOR
Credential: DO
Phone: 810-694-0600