Healthcare Provider Details

I. General information

NPI: 1922109438
Provider Name (Legal Business Name): ENT ASSOCIATES OF JACKSON, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 TENEYCK ST SUITE 100
JACKSON MI
49201-2461
US

IV. Provider business mailing address

1111 TENEYCK ST SUITE 100
JACKSON MI
49201-2461
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-8940
  • Fax: 517-787-9054
Mailing address:
  • Phone: 517-787-8940
  • Fax: 517-787-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEPHEN L KIRKNER
Title or Position: CO-OWNER
Credential: D.O.
Phone: 517-787-8940