Provider Demographics
NPI:1245393412
Name:MUNCIE OTOLARYNGOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:MUNCIE OTOLARYNGOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PHILIPPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-284-2172
Mailing Address - Street 1:2525 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3409
Mailing Address - Country:US
Mailing Address - Phone:765-284-2172
Mailing Address - Fax:765-288-1292
Practice Address - Street 1:2525 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3409
Practice Address - Country:US
Practice Address - Phone:765-284-2172
Practice Address - Fax:765-288-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107020Medicaid
IN100107020Medicaid