# GIFFIN ENT LLC

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

## Provider details

- **NPI number:** 1588611537
- **Authorized official:** CHARLES S GIFFIN M.D. (OWNER)
- **Authorized official phone:** (260) 625-5071

## Contact information

- **Practice address:** 2516 E DUPONT RD, FORT WAYNE, IN 46825-1608
- **Practice address phone:** (260) 625-5071
- **Practice address fax:** (260) 625-5072
- **Mailing address:** 15450 BRIDGEWATER CLUB BLVD, CARMEL, IN 46033-8108
- **Mailing address phone:** (260) 625-5071
- **Mailing address fax:** (260) 625-5072

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | — | NULL | Yes |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 10/04/2007