Healthcare Provider Details

I. General information

NPI: 1881991230
Provider Name (Legal Business Name): SINUS CENTER OF AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 REGENCY CT 210
TOLEDO OH
43623-3091
US

IV. Provider business mailing address

1000 REGENCY CT 210
TOLEDO OH
43623-3091
US

V. Phone/Fax

Practice location:
  • Phone: 567-455-0300
  • Fax:
Mailing address:
  • Phone: 567-455-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.057206
License Number StateOH

VIII. Authorized Official

Name: THOMAS A KWYER
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 567-455-0300