Provider Demographics
NPI:1881819092
Name:ENT ASSOCIATES SC
Entity Type:Organization
Organization Name:ENT ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-271-4141
Mailing Address - Street 1:2315 N LAKE DR STE 1005
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4516
Mailing Address - Country:US
Mailing Address - Phone:414-271-4141
Mailing Address - Fax:414-271-4343
Practice Address - Street 1:2315 N LAKE DR STE 1005
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4516
Practice Address - Country:US
Practice Address - Phone:414-271-4141
Practice Address - Fax:414-271-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24504207Y00000X
WI34875207Y00000X
WI40673207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Not Answered207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty