Provider Demographics
NPI:1710939954
Name:THE DOCTORS GROUP P.C.
Entity Type:Organization
Organization Name:THE DOCTORS GROUP P.C.
Other - Org Name:SOUTH CENTRAL ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-781-4267
Mailing Address - Street 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-789-0015
Mailing Address - Fax:269-789-1551
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-789-0015
Practice Address - Fax:269-789-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A31055OtherBCBSM
MIG00000001424OtherBLUE CARE NETWORK
MI0N19240Medicare PIN