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General NPI Number Information
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NPI Number | 1447420625
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Entity Type | Organization
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Legal Business Name | RED CEDAR EAR NOSE THROAT & AUDIOLOGY P.L.L.C.
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 818 W KING ST SUITE 301
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City | OWOSSO
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State | MI
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Zip | 48867-2116
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Country | US
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Telephone | 989-729-4800
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Fax | 989-729-4810
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Provider Business Mailing Address
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Address Line | 818 W KING ST SUITE 301
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City | OWOSSO
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State | MI
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Zip | 48867-2116
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Country | US
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Telephone | 989-729-4800
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Fax | 989-729-4810
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANNON T RADGENS
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Credential | DO
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Telephone | 989-729-4800
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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 | 5101013241
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License Number State | MI
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