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General NPI Number Information
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NPI Number | 1457321721
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Entity Type | Organization
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Legal Business Name | TRI-STATE EAR, NOSE, AND THROAT SURGEONS, INC.
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 350 W COLUMBIA ST SUITE 310
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City | EVANSVILLE
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State | IN
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Zip | 47710-1782
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Country | US
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Telephone | 812-425-4646
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Fax | 812-467-7209
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Provider Business Mailing Address
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Address Line | 350 W COLUMBIA ST SUITE 310
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City | EVANSVILLE
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State | IN
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Zip | 47710-1782
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Country | US
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Telephone | 812-425-4646
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Fax | 812-467-7209
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID T. WAHLE
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Credential | M.D.
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Telephone | 812-425-4646
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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 | 50001145A
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License Number State | IN
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