Healthcare Provider Details

I. General information

NPI: 1114632932
Provider Name (Legal Business Name): ENT CARE OF MICHIGAN PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 HIGHLAND RD STE 230
WATERFORD MI
48327-1973
US

IV. Provider business mailing address

5220 HIGHLAND RD STE 230
WATERFORD MI
48327-1973
US

V. Phone/Fax

Practice location:
  • Phone: 248-254-8900
  • Fax: 248-599-7191
Mailing address:
  • Phone: 248-254-8900
  • Fax: 248-599-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: ERIC SUCCAR
Title or Position: OWNER
Credential: MD
Phone: 248-254-8900