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General NPI Number Information
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NPI Number | 1679631360
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Entity Type | Organization
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Legal Business Name | MICHIGAN PEDIATRIC ENT ASSOCIATES, PLLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 7001 ORCHARD LAKE RD SUITE 320C
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3604
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Country | US
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Telephone | 248-571-3600
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Fax | 248-973-8560
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Provider Business Mailing Address
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Address Line | 7001 ORCHARD LAKE RD SUITE 320C
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3604
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Country | US
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Telephone | 248-571-3600
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Fax | 248-973-8560
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. LYNN DENHARDT
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Credential |
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Telephone | 248-847-3210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 4301026037
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 5101010352
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 5101009481
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 4301085240
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License Number State | MI
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