Provider Demographics
NPI:1316965767
Name:PETOSKEY EAR NOSE & THROAT SPECIALISTS PLLC
Entity type:Organization
Organization Name:PETOSKEY EAR NOSE & THROAT SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-3277
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-3277
Mailing Address - Fax:231-487-6167
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-3277
Practice Address - Fax:231-487-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010103761207YX0905X
MI1601000006237600000X
MI1601000140237600000X
MI207Y00000X
MI4301086459207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty