Organization
COMMONWEALTH EAR NOSE & THROAT-HEAD & NECK CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HARRIET G SELLERS (CERTIFIED CODING PROFESSIONAL)
(502) 893-0159
Entity
Organization
Contact information
Practice address
DEPARTMENT 8033, CAROL STREAM, IL 60122-8033
(502) 893-0159
Mailing address
4004 DUPONT CIRCLE, LOUISVILLE, KY 40207
(502) 893-0159
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100011000A
—
IN
05
—
65912396
—
KY
01
—
CB7082
RR MEDICARE PIN NUMBER
—
Enumeration date
12/04/2006
Last updated
09/22/2009
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