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General NPI Number Information
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NPI Number | 1295726198
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Entity Type | Organization
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Legal Business Name | EAR, NOSE AND THROAT OF MICHIANA P.C.
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 209 FLORENCE AVENUE
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City | GRANGER
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State | IN
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Zip | 46530-8048
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Country | US
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Telephone | 574-246-1000
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Fax | 574-246-4000
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Provider Business Mailing Address
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Address Line | 209 FLORENCE AVENUE
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City | GRANGER
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State | IN
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Zip | 46530-8048
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Country | US
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Telephone | 574-246-1000
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Fax | 574-246-4000
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID A CAMPBELL
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Credential | MD
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Telephone | 574-246-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01035158A
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License Number State | IN
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