Provider Demographics
NPI:1063639870
Name:THOMAS W PFENNIG DO
Entity Type:Organization
Organization Name:THOMAS W PFENNIG DO
Other - Org Name:GRAND RAPIDS EAR NOSE AND THROAT PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:PFENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-249-8000
Mailing Address - Street 1:1555 44TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4395
Mailing Address - Country:US
Mailing Address - Phone:616-249-8000
Mailing Address - Fax:
Practice Address - Street 1:1555 - 44TH STREET SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509
Practice Address - Country:US
Practice Address - Phone:616-249-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty