Provider Demographics
NPI:1407987688
Name:MICHIGAN OTOLARYNGOLOGY SURGERY
Entity Type:Organization
Organization Name:MICHIGAN OTOLARYNGOLOGY SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-434-3200
Mailing Address - Street 1:5333 MCAULEY DR.
Mailing Address - Street 2:SUITE 2017
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-434-3200
Mailing Address - Fax:734-434-3209
Practice Address - Street 1:5333 MCAULEY DR.
Practice Address - Street 2:SUITE 2017
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-434-3200
Practice Address - Fax:734-434-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherEIN
MI=========OtherEIN
MI0H16076Medicare PIN