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General NPI Number Information
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NPI Number | 1932374394
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Entity Type | Organization
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Legal Business Name | DEARBORN EAR NOSE AND THROAT CLINIC
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 15212 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48126-3497
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Country | US
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Telephone | 313-582-8853
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Fax | 313-582-6417
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Provider Business Mailing Address
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Address Line | 15212 MICHIGAN AVE
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City | DEARBORN
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State | MI
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Zip | 48126-3497
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Country | US
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Telephone | 313-582-8853
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Fax | 313-582-6417
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN AUSTIN FINK
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Credential | MD
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Telephone | 313-582-8853
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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 | 4301026530
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License Number State | MI
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