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General NPI Number Information
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NPI Number | 1659421048
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Entity Type | Organization
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Legal Business Name | PROCTOR ENT PLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 2251 N SQUIRREL RD SUITE 105
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City | AUBURN HILLS
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State | MI
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Zip | 48326-4600
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Country | US
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Telephone | 248-648-8100
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Fax | 248-648-8060
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Provider Business Mailing Address
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Address Line | 2251 N SQUIRREL RD SUITE 105
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City | AUBURN HILLS
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State | MI
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Zip | 48326-4600
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Country | US
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Telephone | 248-648-8100
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Fax | 248-648-8060
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TODD B PROCTOR
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Credential | M.D.
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Telephone | 248-648-8100
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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 | TP054694
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License Number State | MI
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