Organization
LIVINGSTON ENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON L JASCOE (OFFICE MANAGER)
(810) 227-3687
Entity
Organization
Contact information
Practice address
2300 GENOA BUSINESS PARK DR, SUITE 130, BRIGHTON, MI 48114-7367
(810) 227-3687
(810) 225-2209
Mailing address
2300 GENOA BUSINESS PARK DR, SUITE 130, BRIGHTON, MI 48114-7367
(810) 227-3687
(810) 225-2209
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301053044
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301053044
BCBS ID
MI
01
—
F51824
UPIN
MI
Enumeration date
02/03/2010
Last updated
02/03/2010
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