Provider Demographics
NPI:1285803346
Name:LAKESHORE EAR NOSE AND THROAT CENTER PC
Entity type:Organization
Organization Name:LAKESHORE EAR NOSE AND THROAT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DJ
Authorized Official - Last Name:MEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-254-7200
Mailing Address - Street 1:11080 HALL RD
Mailing Address - Street 2:A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1511
Mailing Address - Country:US
Mailing Address - Phone:586-254-7200
Mailing Address - Fax:586-254-7201
Practice Address - Street 1:11080 HALL RD
Practice Address - Street 2:A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1511
Practice Address - Country:US
Practice Address - Phone:586-254-7200
Practice Address - Fax:586-254-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2370886005OtherCIGNA
MI4351803OtherAETNA
MI2416918002OtherCIGNA
MI4103187Medicaid
MI4103196Medicaid
MI4218043OtherAETNA
MI5791268OtherAETNA
MI0225988007OtherCIGNA
MI1203527Medicaid
MI131309OtherCARE CHOICES
MI43331258OtherAETNA
MI111857OtherCARE CHOICES
MI2355682001OtherCIGNA
MI103348OtherCARE CHOICES
MI131306OtherCARE CHOICES
MI2401315001OtherCIGNA
MI1124737Medicaid
MI3044902Medicaid
MI4408911OtherAETNA