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General NPI Number Information
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NPI Number | 1861464182
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Entity Type | Organization
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Legal Business Name | MORELAND EAR NOSE & THROAT GROUP LTD
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 1111 DELAFIELD ST SUITE 102
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City | WAUKESHA
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State | WI
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Zip | 53188-3417
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Country | US
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Telephone | 262-547-1614
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 DELAFIELD ST SUITE 102
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City | WAUKESHA
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State | WI
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Zip | 53188-3417
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Country | US
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Telephone | 262-547-1614
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Fax |
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Authorized Official
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Title or Position | OTOLARYNGOLOGIST
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Name | THOMAS PATRICK BELSON
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Credential | M.D.
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Telephone | 262-547-1614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 15625
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License Number State | WI
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