Organization
MICHIGAN PEDIATRIC ENT ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYNN DENHARDT (PRACTICE MANAGER)
(248) 847-3210
Entity
Organization
Contact information
Practice address
7001 ORCHARD LAKE RD, SUITE 320C, WEST BLOOMFIELD, MI 48322-3604
(248) 571-3600
(248) 973-8560
Mailing address
7001 ORCHARD LAKE RD, SUITE 320C, WEST BLOOMFIELD, MI 48322-3604
(248) 571-3600
(248) 973-8560
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
4301026037
MI
207YP0228X
Pediatric Otolaryngology Physician
Primary
4301085240
MI
207YP0228X
Pediatric Otolaryngology Physician
5101009481
MI
207YP0228X
Pediatric Otolaryngology Physician
5101010352
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040E011990
BCBS OF MI
MI
05
—
418928011
—
MI
05
—
418929911
—
MI
05
—
418930511
—
MI
05
—
418933210
—
MI
05
—
418935010
—
MI
05
—
418937910
—
MI
05
—
418941211
—
MI
05
—
418942111
—
MI
05
—
418944011
—
MI
05
—
519222510
—
MI
05
—
519253910
—
MI
05
—
519559510
—
MI
Enumeration date
12/05/2006
Last updated
05/18/2016
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