=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639674435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST SHORE OTOLARYNGOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2018
-----------------------------------------------------
Last Update Date | 07/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1450 FARR RD STE 5000
-----------------------------------------------------
City | NORTON SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49444-7789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-777-2625
-----------------------------------------------------
Fax | 231-773-8560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1450 FARR RD STE 5000
-----------------------------------------------------
City | NORTON SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49444-7789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-739-9095
-----------------------------------------------------
Fax | 231-722-5147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | PAUL E LOMEO
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 231-777-2625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------