Organization
MIDWEST EAR NOSE AND THROAT SURGERY, PSC
Active
Other names
Midwest Otolarngology
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA DENTON (CREDENTIALING REP)
(812) 473-2060
Entity
Organization
Contact information
Practice address
1401 PROFESSIONAL BLVD, EVANSVILLE, IN 47714-8014
(812) 473-2060
(812) 473-0763
Mailing address
1401 PROFESSIONAL BLVD, EVANSVILLE, IN 47714-8014
(812) 473-2060
(812) 473-0763
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200069270A
—
IN
05
—
200069270D
—
IN
05
—
65937542
—
KY
Enumeration date
06/09/2005
Last updated
09/13/2024
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