Organization
BURLINGTON EAR NOSE & THROAT CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS EDWIN HENRICH M.D. (PHYSICIAN)
(319) 752-2725
Entity
Organization
Contact information
Practice address
1225 S GEAR AVE, STE 255, WEST BURLINGTON, IA 52655-1687
(319) 752-2725
(319) 753-1084
Mailing address
1225 S GEAR AVE, STE 255, WEST BURLINGTON, IA 52655-1687
(319) 752-2725
(319) 753-1084
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
31549 / 34553
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06724
WELLMARK GROUP NUMBER
IA
01
—
1326157140
MEDICARE GROUP NPI
—
01
—
I5597
MEDICARE ID
IA
Enumeration date
08/29/2006
Last updated
02/24/2015
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