Provider Demographics
NPI:1114077641
Name:SUPERIOR EAR, NOSE & THROAT SPECIALISTS. P.C.
Entity Type:Organization
Organization Name:SUPERIOR EAR, NOSE & THROAT SPECIALISTS. P.C.
Other - Org Name:SUPERIOR ENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-7660
Mailing Address - Street 1:712 CHIPPEWA SQ STE 130
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4827
Mailing Address - Country:US
Mailing Address - Phone:906-225-7660
Mailing Address - Fax:906-225-7665
Practice Address - Street 1:712 CHIPPEWA SQ STE 130
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4827
Practice Address - Country:US
Practice Address - Phone:906-225-7660
Practice Address - Fax:906-225-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4865320Medicaid
MI0405210741OtherBLUE CROSS BLUE SHIELD
MI0405210741OtherBLUE CROSS BLUE SHIELD