| Downriver Ent PC | |
|
14575 Southfield Rd Allen Park MI 48101-2640 | |
| (313) 381-5170 | |
| (313) 381-8790 |
| Full Name | Downriver Ent PC |
|---|---|
| Speciality | Clinic/Center |
| Location | 14575 Southfield Rd, Allen Park, Michigan |
| Authorized Official Name and Position | Lascelles Pinnock (OTOLARYNGOLOGY) |
| Authorized Official Contact | 3133815170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Downriver Ent PC 14575 Southfield Rd Allen Park MI 48101-2640 Ph: (313) 381-5170 | Downriver Ent PC 14575 Southfield Rd Allen Park MI 48101-2640 Ph: (313) 381-5170 |
| NPI Number | 1134304595 |
|---|---|
| Provider Enumeration Date | 01/04/2008 |
| Last Update Date | 11/17/2014 |
| Medicare PECOS PAC ID | 6305933326 |
|---|---|
| Medicare Enrollment ID | O20080104000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134304595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | LP042960 (Michigan) | Primary |
| 207Y00000X | Otolaryngology | (NU) | Secondary |
| 231H00000X | Audiologist | (NU) | Secondary |
| Provider Name | Lascelles Pinnock |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1295766137 PECOS PAC ID: 7810916418 Enrollment ID: I20051115000131 |
| Provider Name | Mira J Brooks |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1326136060 PECOS PAC ID: 0749288322 Enrollment ID: I20061114000432 |
| Provider Name | Laura S Curtis |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1437212750 PECOS PAC ID: 3971608209 Enrollment ID: I20121126000562 |
| Provider Name | Joseph M Seymour |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1184884611 PECOS PAC ID: 7719129345 Enrollment ID: I20130812000563 |
| Provider Name | Martin J Mahoney |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1417263609 PECOS PAC ID: 8628203007 Enrollment ID: I20131022000383 |
| Provider Name | Radhika Sokhal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407211428 PECOS PAC ID: 4284927195 Enrollment ID: I20160728002478 |
| Provider Name | Brian M Grossman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366949596 PECOS PAC ID: 7517221096 Enrollment ID: I20180509001470 |
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