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General NPI Number Information
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NPI Number | 1689732836
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH EAR NOSE & THROAT-HEAD & NECK CENTER
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | DEPARTMENT 8033
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City | CAROL STREAM
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State | IL
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Zip | 60122-8033
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Country | US
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Telephone | 502-893-0159
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Fax |
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Provider Business Mailing Address
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Address Line | 4004 DUPONT CIRCLE
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City | LOUISVILLE
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State | KY
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Zip | 40207
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Country | US
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Telephone | 502-893-0159
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Fax |
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Authorized Official
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Title or Position | CERTIFIED CODING PROFESSIONAL
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Name | MS. HARRIET G SELLERS
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Credential |
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Telephone | 502-893-0159
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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 |
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License Number State |
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