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General NPI Number Information
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NPI Number | 1316938806
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Entity Type | Organization
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Legal Business Name | EAR NOSE & THROAT FACIAL SUGERY CENTER PA
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1726 MEDICAL BLVD SUITE 201
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City | NAPLES
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State | FL
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Zip | 34110-1426
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Country | US
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Telephone | 239-594-7774
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Fax | 239-594-5974
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Provider Business Mailing Address
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Address Line | 1726 MEDICAL BLVD SUITE 201
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City | NAPLES
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State | FL
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Zip | 34110-1426
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Country | US
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Telephone | 239-594-7774
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Fax | 239-594-5974
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARILYN JUNE MALIK
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Credential | MD
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Telephone | 239-594-7774
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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 | ME86099
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License Number State | FL
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