Healthcare Provider Details

I. General information

NPI: 1265259618
Provider Name (Legal Business Name): GLB ENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E MAIN ST STE 115
MIDLAND MI
48640-5488
US

IV. Provider business mailing address

PO BOX 3272
SAGINAW MI
48605-3272
US

V. Phone/Fax

Practice location:
  • Phone: 989-486-1457
  • Fax: 989-486-1479
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDICE COLBY-SCOTT
Title or Position: OWNER
Credential: MD
Phone: 989-486-1457