Provider Demographics
NPI:1265417729
Name:COASTAL EAR NOSE & THROAT PA
Entity type:Organization
Organization Name:COASTAL EAR NOSE & THROAT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-677-8808
Mailing Address - Street 1:1050 W GRANADA BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8154
Mailing Address - Country:US
Mailing Address - Phone:386-677-8808
Mailing Address - Fax:386-677-9919
Practice Address - Street 1:1050 W GRANADA BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8154
Practice Address - Country:US
Practice Address - Phone:386-677-8808
Practice Address - Fax:386-677-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21397Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #