| Lakeshore Ear Nose And Throat Center Pc | |
|
21000 E 12 Mile Rd Ste 111 Saint Clair Shores MI 48081-1116 | |
| (586) 779-7610 | |
| Not Available |
| Full Name | Lakeshore Ear Nose And Throat Center Pc |
|---|---|
| Speciality | Allergy & Immunology |
| Location | 21000 E 12 Mile Rd, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Daniel Dj Megler (PRESIDENT -CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5867797610 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Ear Nose And Throat Center Pc 21000 E 12 Mile Rd Ste 111 Saint Clair Shores MI 48081-1116 Ph: (586) 779-7610 | Lakeshore Ear Nose And Throat Center Pc 21000 E 12 Mile Rd Ste 111 Saint Clair Shores MI 48081-1116 Ph: (586) 779-7610 |
| NPI Number | 1194921692 |
|---|---|
| Provider Enumeration Date | 06/22/2007 |
| Last Update Date | 10/12/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194921692 | NPI | - | NPPES |
| 1108206701 | Other | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207K00000X | Allergy & Immunology | (* (Not Available)) | Primary |
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