Provider Demographics
NPI:1861464182
Name:MORELAND EAR NOSE & THROAT GROUP LTD
Entity Type:Organization
Organization Name:MORELAND EAR NOSE & THROAT GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTOLARYNGOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-547-1614
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-547-1614
Mailing Address - Fax:
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-547-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15625174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31224500Medicaid
WI390708553OtherDR. EDWARD KASS SS#
WI31213300Medicaid
WI396425705OtherDR. WILLIAM DARLING SS#
WI31837100Medicaid
WI3122500Medicaid
WI399564070OtherDR. MARY FOX SS#
WI398403074OtherDR. RONALD DARLING
WI34012700Medicaid
WI391303765OtherDR. THOMAS BELSON
WI000168770Medicare PIN
WI391303765OtherDR. THOMAS BELSON
WIF33800Medicare UPIN
WIH24218Medicare UPIN
WI31213300Medicaid
WI000368770Medicare PIN
WI31837100Medicaid
WI000468770Medicare PIN
WI000868770Medicare PIN
WI390708553OtherDR. EDWARD KASS SS#