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General NPI Number Information
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NPI Number | 1356394803
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Entity Type | Organization
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Legal Business Name | NORTHWOODS EAR, NOSE & THROAT PC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 2611 CHARLEVOIX AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-8524
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Country | US
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Telephone | 231-348-5900
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Fax | 231-348-5901
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Provider Business Mailing Address
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Address Line | 2611 CHARLEVOIX AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-8524
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Country | US
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Telephone | 231-348-5900
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Fax | 231-348-5901
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Authorized Official
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Title or Position | OWNER
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Name | JAMES J SLATER
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Credential | D.O.
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Telephone | 231-348-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 5101015870
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License Number State | MI
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