Healthcare Provider Details

I. General information

NPI: 1134378730
Provider Name (Legal Business Name): EAR, NOSE & THROAT INSTITUTE OF MICHIGAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 LEVAN RD SUITE 206
LIVONIA MI
48154-5083
US

IV. Provider business mailing address

14555 LEVAN RD SUITE 206
LIVONIA MI
48154-5083
US

V. Phone/Fax

Practice location:
  • Phone: 734-953-0990
  • Fax: 734-953-0996
Mailing address:
  • Phone: 734-953-0990
  • Fax: 734-953-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMU012523
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMU012523
License Number StateMI

VIII. Authorized Official

Name: MARK UZANSKY
Title or Position: OWNER
Credential: D.O.
Phone: 734-953-0990