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NPI Code Detail

MEDICARE: GIFFIN ENT LLC

MEDICARE: GIFFIN ENT LLC
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
1207YX0007XPlastic Surgery within the Head & Neck (Otolaryngology) Physician

General Provider Information

NPI Number : 1588611537
Entity Type Code : Organization
Provider Name (Legal Business Name) : GIFFIN ENT LLC
Provider Business Mailing Address
First Line : 15450 BRIDGEWATER CLUB BLVD
Second Line :
City : CARMEL
State : IN
Zip : 46033-8108
Country : US
Telephone Number : 260-625-5071
Fax Number : 260-625-5072
Provider Business Practice Location Address
First Line : 2516 E DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1608
Country : US
Telephone Number : 260-625-5071
Fax Number : 260-625-5072
Authorized Official
Title or Position : OWNER
Name : CHARLES S GIFFIN
Credential : M.D.
Telephone Number : 260-625-5071
Provider Enumeration Date : 05/27/2006
Last Update Date : 10/04/2007

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