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General NPI Number Information
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NPI Number | 1609917186
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Entity Type | Organization
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Legal Business Name | FAMILY EAR NOSE THROAT & ALLERGY
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 961 4 MILE RD NW SUITE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-1502
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Country | US
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Telephone | 616-784-6130
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Fax | 616-784-6140
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Provider Business Mailing Address
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Address Line | 961 4 MILE RD NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-1502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH B GILETTO
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Credential | MD
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Telephone | 616-784-6130
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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 | 4301071148
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License Number State | MI
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