Provider Demographics
NPI:1447420625
Name:RED CEDAR EAR NOSE THROAT & AUDIOLOGY P.L.L.C.
Entity Type:Organization
Organization Name:RED CEDAR EAR NOSE THROAT & AUDIOLOGY P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:T
Authorized Official - Last Name:RADGENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-729-4800
Mailing Address - Street 1:818 W KING ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2116
Mailing Address - Country:US
Mailing Address - Phone:989-729-4800
Mailing Address - Fax:989-729-4810
Practice Address - Street 1:818 W KING ST
Practice Address - Street 2:SUITE 301
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2116
Practice Address - Country:US
Practice Address - Phone:989-729-4800
Practice Address - Fax:989-729-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N94650Medicare PIN