Provider Demographics
NPI:1932374394
Name:DEARBORN EAR NOSE AND THROAT CLINIC
Entity Type:Organization
Organization Name:DEARBORN EAR NOSE AND THROAT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-582-8853
Mailing Address - Street 1:15212 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3497
Mailing Address - Country:US
Mailing Address - Phone:313-582-8853
Mailing Address - Fax:313-582-6417
Practice Address - Street 1:15212 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3497
Practice Address - Country:US
Practice Address - Phone:313-582-8853
Practice Address - Fax:313-582-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301026530207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1796837Medicaid
MI0821564OtherBCBS-MI
MIOP57220Medicare PIN
MI1796837Medicaid