Organization
EAR NOSE AND THROAT CONSULTANTS
Active
Parent organization
EAR NOSE AND THROAT CONSULTANTS
Other names
Fyzical
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAR NOSE AND THROAT CONSULTANTS
Authorized official
KELLY A JERDEE (OFFICE ADMINISTRATOR)
(605) 217-4320
Entity
Organization
Contact information
Practice address
101 TOWER ROAD, SUITE 110, DAKOTA DUNES, SD 57049
(605) 217-4320
(605) 217-2948
Mailing address
101 TOWER ROAD, SUITE 120, DAKOTA DUNES, SD 57049
(605) 217-4320
(605) 217-2948
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1919
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1919
SOUTH DAKOTA LICENSE
SD
Enumeration date
06/07/2016
Last updated
06/29/2016
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