Provider Demographics
NPI:1063913713
Name:INDEPENDENCE EAR, NOSE & THROAT, LLC
Entity type:Organization
Organization Name:INDEPENDENCE EAR, NOSE & THROAT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUSTGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-888-1880
Mailing Address - Street 1:1400 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-1020
Mailing Address - Country:US
Mailing Address - Phone:772-888-1880
Mailing Address - Fax:855-618-2315
Practice Address - Street 1:1400 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-1020
Practice Address - Country:US
Practice Address - Phone:772-285-5334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty