Healthcare Provider Details

I. General information

NPI: 1225073687
Provider Name (Legal Business Name): ENT SURGICAL ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27483 DEQUINDRE RD STE 201
MADISON HEIGHTS MI
48071-5711
US

IV. Provider business mailing address

27483 DEQUINDRE RD STE 201
MADISON HEIGHTS MI
48071-5711
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-0100
  • Fax: 248-399-3960
Mailing address:
  • Phone: 248-541-0100
  • Fax: 248-399-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. WARREN L BRANDES
Title or Position: CEO PRESIDENT
Credential: DO
Phone: 248-541-0100