Provider Demographics
NPI:1295752806
Name:CENTER FOR EAR NOSE THROAT AND ALLERGY PC
Entity type:Organization
Organization Name:CENTER FOR EAR NOSE THROAT AND ALLERGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KROWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-926-1056
Mailing Address - Street 1:12188A N MERIDIAN ST
Mailing Address - Street 2:SUITE 375
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-926-1056
Mailing Address - Fax:317-806-2338
Practice Address - Street 1:12188A N MERIDIAN ST
Practice Address - Street 2:SUITE 375
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-926-1056
Practice Address - Fax:317-806-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50001873A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000101928OtherANTHEM BCBS
IN100065540Medicaid
IN000000101928OtherANTHEM BCBS