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General NPI Number Information
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NPI Number | 1053376731
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Entity Type | Organization
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Legal Business Name | U P OTOLARYNGOLOGY PC
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 2525 5TH AVENUE SOUTH
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City | ESCANABA
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State | MI
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Zip | 49829
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Country | US
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Telephone | 906-786-6047
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Fax | 906-786-0660
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Provider Business Mailing Address
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Address Line | 2525 5TH AVENUE SOUTH
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City | ESCANABA
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State | MI
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Zip | 49829
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Country | US
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Telephone | 906-786-6047
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Fax | 906-786-0660
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Authorized Official
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Title or Position | PRESIDENT SECRETARY
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Name | JOHN A KLIM
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Credential | DO
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Telephone | 906-786-6047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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