Organization
UNIVERSITY OTOLARYNGOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON BRANKA (COORDINATOR)
(313) 745-1740
Entity
Organization
Contact information
Practice address
27177 LAHSER RD, SUITE 203, SOUTHFIELD, MI 48034-4714
(248) 357-4151
Mailing address
3800 WOODWARD AVE, SUITE 600, DETROIT, MI 48201-2061
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H27877
BCBSM GROUP NUMBER
MI
Enumeration date
03/21/2007
Last updated
08/22/2020
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