Healthcare Provider Details

I. General information

NPI: 1316965767
Provider Name (Legal Business Name): PETOSKEY EAR NOSE & THROAT SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W MITCHELL ST SUITE 250
PETOSKEY MI
49770-2275
US

IV. Provider business mailing address

560 W MITCHELL ST SUITE 250
PETOSKEY MI
49770-2275
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-3277
  • Fax: 231-487-6167
Mailing address:
  • Phone: 231-487-3277
  • Fax: 231-487-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301086459
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number51010103761
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000006
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000140
License Number StateMI

VIII. Authorized Official

Name: DR. MARC A FEELEY
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 231-487-3277