Organization
OTOLARYNGOLOGY HEAD & NECK SURGERY, P.A.
Active
Other names
Midwest Ear, Nose & Throat Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY BENUSA (CEO)
(651) 702-0750
Entity
Organization
Contact information
Practice address
217 RADIO DR, WOODBURY, MN 55125-5805
(651) 702-0750
(651) 645-6166
Mailing address
215 RADIO DR STE 202, WOODBURY, MN 55125-5822
(651) 702-0750
(651) 645-6166
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
20
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821195959
MEDICARE PTAN C00273
MN
05
—
1821195959
—
MN
Enumeration date
04/10/2009
Last updated
02/26/2025
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