Provider Demographics
NPI:1083659932
Name:CENTER FOR EAR,NOSE AND THROAT PC
Entity Type:Organization
Organization Name:CENTER FOR EAR,NOSE AND THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:KIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-668-1104
Mailing Address - Street 1:2300 HAGGERTY RD STE 2130
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2191
Mailing Address - Country:US
Mailing Address - Phone:248-668-1104
Mailing Address - Fax:248-668-1096
Practice Address - Street 1:2300 HAGGERTY ROAD
Practice Address - Street 2:SUITE 2130
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323
Practice Address - Country:US
Practice Address - Phone:248-668-1104
Practice Address - Fax:248-668-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010029207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4233036OtherAETNA
MI040F338670OtherBCN
MI82908OtherPHCS
MIF31235OtherHAP
MI101058OtherGREAT LAKES
MI4100372Medicaid
MI040015528OtherRAILROAD MEDICARE
MI0456336254OtherBCBC BCN
MIB9900OtherMCARE
MI2886OtherCAPE
MI040F338670OtherBCBS GROUP
MI1009579OtherGREAT WEST
MI107796OtherCARE CHOICES
MI12043OtherDMC