Organization
ENT SURGICAL ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ILENE MILES (ADMINISTRATOR)
(248) 541-1620
Entity
Organization
Contact information
Practice address
27483 DEQUINDRE RD, SUITE 201, MADISON HEIGHTS, MI 48071-5711
(248) 541-0100
(248) 399-3960
Mailing address
27483 DEQUINDRE RD, SUITE 201, MADISON HEIGHTS, MI 48071-5711
(248) 541-0100
(248) 399-3960
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4812602
—
MI
05
—
4812620
—
MI
05
—
4812630
—
MI
05
—
4812649
—
MI
05
—
4985355
—
MI
05
—
4985364
—
MI
05
—
4985373
—
MI
05
—
4985391
—
MI
05
—
5255970
—
MI
01
—
540F336540
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
01
—
640F336900
BLUE CARE NETWORK
MI
01
—
640F361620
BCBS
MI
Enumeration date
07/17/2008
Last updated
12/09/2008
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