Organization
SAULT OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK A WALLACE DO (PRESIDENT)
(808) 937-7037
Entity
Organization
Contact information
Practice address
333 MAGAZINE ST, STE 101, SAULT SAINTE MARIE, MI 49783-1867
(906) 259-0244
(906) 259-0247
Mailing address
333 MAGAZINE ST, STE 101, SAULT SAINTE MARIE, MI 49783-1867
(906) 259-0244
(906) 259-0247
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
5101015234
MI
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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