MEDICARE: CENTER FOR EAR,NOSE AND THROAT PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	5101010029	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	040015528	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4233036	OTHER	MI	AETNA
2	040F338670	OTHER	MI	BCN
3	82908	OTHER	MI	PHCS
4	F31235	OTHER	MI	HAP
5	101058	OTHER	MI	GREAT LAKES
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0456336254	OTHER	MI	BCBC BCN
9	B9900	OTHER	MI	MCARE
10	2886	OTHER	MI	CAPE
11	040F338670	OTHER	MI	BCBS GROUP
12	1009579	OTHER	MI	GREAT WEST
13	107796	OTHER	MI	CARE CHOICES
14	12043	OTHER	MI	DMC

General Provider Information

NPI Number	:	1083659932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR EAR,NOSE AND THROAT PC

Provider Business Mailing Address
First Line	:	2300 HAGGERTY RD STE 2130
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2191
Country	:	US
Telephone Number	:	248-668-1104
Fax Number	:	248-668-1096

Provider Business Practice Location Address
First Line	:	2300 HAGGERTY ROAD
Second Line	:	SUITE 2130
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323
Country	:	US
Telephone Number	:	248-668-1104
Fax Number	:	248-668-1096

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	STEVEN JOE KIN
Credential	:	DO
Telephone Number	:	248-668-1104

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	02/06/2019

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Directions to “CENTER FOR EAR,NOSE AND THROAT PC ” Practice Location

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