# SAULT OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY PC

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

## Provider details

- **NPI number:** 1699028613
- **Authorized official:** MARK A WALLACE DO (PRESIDENT)
- **Authorized official phone:** (808) 937-7037

## Contact information

- **Practice address:** 333 MAGAZINE ST, STE 101, SAULT SAINTE MARIE, MI 49783-1867
- **Practice address phone:** (906) 259-0244
- **Practice address fax:** (906) 259-0247
- **Mailing address:** 333 MAGAZINE ST, STE 101, SAULT SAINTE MARIE, MI 49783-1867
- **Mailing address phone:** (906) 259-0244
- **Mailing address fax:** (906) 259-0247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | 5101015234 | MI | Yes |

## Other

- **Enumeration date:** 10/16/2012
- **Last updated:** 10/16/2012