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General NPI Number Information
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NPI Number | 1487607768
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Entity Type | Organization
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Legal Business Name | ASSOCIATED EAR NOSE AND THROAT SPECIALISTS, PC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2802 LEONARD DRIVE
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City | VALPARAISO
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State | IN
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Zip | 46383
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Country | US
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Telephone | 219-531-0355
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Fax | 219-548-7568
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Provider Business Mailing Address
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Address Line | 2802 LEONARD DRIVE
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City | VALPARAISO
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State | IN
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Zip | 46383
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Country | US
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Telephone | 219-531-0355
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Fax | 219-548-7568
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL J KEENAN
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Credential | MD
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Telephone | 219-531-0355
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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 | 50004650A
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License Number State | IN
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