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General NPI Number Information
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NPI Number | 1922109438
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Entity Type | Organization
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Legal Business Name | ENT ASSOCIATES OF JACKSON, P.C.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 1111 TENEYCK ST SUITE 100
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City | JACKSON
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State | MI
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Zip | 49201-2461
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Country | US
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Telephone | 517-787-8940
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Fax | 517-787-9054
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Provider Business Mailing Address
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Address Line | 1111 TENEYCK ST SUITE 100
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City | JACKSON
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State | MI
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Zip | 49201-2461
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Country | US
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Telephone | 517-787-8940
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Fax | 517-787-9054
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. STEPHEN L KIRKNER
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Credential | D.O.
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Telephone | 517-787-8940
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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 | MI
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