# NORTHWOODS EAR, NOSE & THROAT PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356394803
- **Authorized official:** JAMES J SLATER D.O. (OWNER)
- **Authorized official phone:** (231) 348-5900

## Contact information

- **Practice address:** 2611 CHARLEVOIX AVE, PETOSKEY, MI 49770-8524
- **Practice address phone:** (231) 348-5900
- **Practice address fax:** (231) 348-5901
- **Mailing address:** 2611 CHARLEVOIX AVE, PETOSKEY, MI 49770-8524
- **Mailing address phone:** (231) 348-5900
- **Mailing address fax:** (231) 348-5901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | 5101015870 | MI | Yes |

## Other

- **Enumeration date:** 05/18/2006
- **Last updated:** 05/11/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1751601125 | BCBS | MI |
| 05 | — | 4832946-11 | — | MI |