Provider Demographics
NPI:1659421048
Name:PROCTOR ENT PLC
Entity Type:Organization
Organization Name:PROCTOR ENT PLC
Other - Org Name:CONRAD PROCTOR MD & TODD PROCTOR MD PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:B
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-648-8100
Mailing Address - Street 1:2251 N SQUIRREL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4600
Mailing Address - Country:US
Mailing Address - Phone:248-648-8100
Mailing Address - Fax:248-648-8060
Practice Address - Street 1:2251 N SQUIRREL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4600
Practice Address - Country:US
Practice Address - Phone:248-648-8100
Practice Address - Fax:248-648-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITP054694207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477758944OtherLAURA J CURCIO AUD - NPI
MI3394295Medicaid
MI1316929250OtherTODD PROCTOR MD - NPI
MI3394295Medicaid
MI1316929250OtherTODD PROCTOR MD - NPI
MI0M23890Medicare PIN
MI0M23890Medicare PIN
MIB4590OtherCONRAD PROCTOR MD - MCARE
MIB44281Medicare UPIN
1477758944OtherLAURA J CURCIO AUD - NPI