MEDICARE: COMMONWEALTH EAR NOSE & THROAT-HEAD & NECK CENTER

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	207Y00000X	Otolaryngology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB7082	OTHER		RR MEDICARE PIN NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689732836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH EAR NOSE & THROAT-HEAD & NECK CENTER

Provider Business Mailing Address
First Line	:	4004 DUPONT CIRCLE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207
Country	:	US
Telephone Number	:	502-893-0159
Fax Number	:

Provider Business Practice Location Address
First Line	:	DEPARTMENT 8033
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-8033
Country	:	US
Telephone Number	:	502-893-0159
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED CODING PROFESSIONAL
Name	:	MS. HARRIET G SELLERS
Credential	:
Telephone Number	:	502-893-0159

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/22/2009

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Directions to “COMMONWEALTH EAR NOSE & THROAT-HEAD & NECK CENTER ” Practice Location

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