MEDICARE: SINUS CENTER OF AMERICA 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
1	207Y00000X	Otolaryngology Physician	35.057206	OH

General Provider Information

NPI Number	:	1881991230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SINUS CENTER OF AMERICA LLC

Provider Business Mailing Address
First Line	:	1000 REGENCY CT
Second Line	:	210
City	:	TOLEDO
State	:	OH
Zip	:	43623-3091
Country	:	US
Telephone Number	:	567-455-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 REGENCY CT
Second Line	:	210
City	:	TOLEDO
State	:	OH
Zip	:	43623-3091
Country	:	US
Telephone Number	:	567-455-0300
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	THOMAS A KWYER
Credential	:	MD
Telephone Number	:	567-455-0300

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	02/28/2011

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