Provider Demographics
NPI:1316938806
Name:EAR NOSE & THROAT FACIAL SUGERY CENTER PA
Entity type:Organization
Organization Name:EAR NOSE & THROAT FACIAL SUGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARILYN
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-594-7774
Mailing Address - Street 1:1726 MEDICAL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1426
Mailing Address - Country:US
Mailing Address - Phone:239-594-7774
Mailing Address - Fax:239-594-5974
Practice Address - Street 1:1726 MEDICAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1426
Practice Address - Country:US
Practice Address - Phone:239-594-7774
Practice Address - Fax:239-594-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86099207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375972Medicare ID - Type Unspecified
D10982Medicare UPIN