Organization
OTORHINOLARYNGOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL W KLETZING MD (PRESIDENT)
(574) 232-4800
Entity
Organization
Contact information
Practice address
621 MEMORIAL DR, SUITE 402, SOUTH BEND, IN 46601-1063
(574) 232-4800
Mailing address
PO BOX 1916, SOUTH BEND, IN 46634-1916
(574) 232-4800
(574) 282-1018
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100465500
—
IN
01
—
207Y00000X
OTO TAXONOMY
IN
01
—
207YX0602Y
ALLERGY TAXONOMY 1
IN
01
—
207YX0905X
FACIAL PLASTIC TAXONOMY
IN
01
—
35157729
TAX IDENTIFICATION
IN
Enumeration date
06/21/2006
Last updated
10/29/2009
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