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General NPI Number Information
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NPI Number | 1780979153
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Entity Type | Organization
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Legal Business Name | SHORELINE ENT OF WEST MICHIGAN PC
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 268 SEMINOLE RD
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City | NORTON SHORES
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State | MI
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Zip | 49444-3733
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Country | US
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Telephone | 231-777-2625
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Fax | 231-773-8560
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Provider Business Mailing Address
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Address Line | 268 SEMINOLE RD
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City | NORTON SHORES
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State | MI
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Zip | 49444-3733
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Country | US
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Telephone | 231-777-2625
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Fax | 231-773-8560
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL H BELANGER
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Credential | D.O.
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Telephone | 231-777-2625
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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 | MI5101015391
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License Number State | MI
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