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General NPI Number Information
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NPI Number | 1285803346
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Entity Type | Organization
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Legal Business Name | LAKESHORE EAR NOSE AND THROAT CENTER PC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 11080 HALL RD A
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1511
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Country | US
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Telephone | 586-254-7200
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Fax | 586-254-7201
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Provider Business Mailing Address
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Address Line | 11080 HALL RD A
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1511
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Country | US
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Telephone | 586-254-7200
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Fax | 586-254-7201
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL DJ MEGLER
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Credential | MD
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Telephone | 586-254-7200
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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 | MI
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