Healthcare Provider Details

I. General information

NPI: 1285803346
Provider Name (Legal Business Name): LAKESHORE EAR NOSE AND THROAT CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11080 HALL RD A
STERLING HEIGHTS MI
48314-1511
US

IV. Provider business mailing address

11080 HALL RD A
STERLING HEIGHTS MI
48314-1511
US

V. Phone/Fax

Practice location:
  • Phone: 586-254-7200
  • Fax: 586-254-7201
Mailing address:
  • Phone: 586-254-7200
  • Fax: 586-254-7201

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. DANIEL DJ MEGLER
Title or Position: PRESIDENT
Credential: MD
Phone: 586-254-7200