Organization
LAKESHORE EAR NOSE AND THROAT CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL DJ MEGLER MD (PRESIDENT -CHIEF EXECUTIVE OFFICER)
(586) 779-7610
Entity
Organization
Contact information
Practice address
21000 E 12 MILE RD, STE 111, SAINT CLAIR SHORES, MI 48081-1116
(586) 779-7610
Mailing address
21000 E 12 MILE RD, STE 111, SAINT CLAIR SHORES, MI 48081-1116
(586) 779-7610
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1108206701
BLUE SHIELD
—
Enumeration date
06/22/2007
Last updated
10/12/2007
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