Provider Demographics
NPI:1053376731
Name:U P OTOLARYNGOLOGY PC
Entity type:Organization
Organization Name:U P OTOLARYNGOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:906-786-6047
Mailing Address - Street 1:2525 5TH AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829
Mailing Address - Country:US
Mailing Address - Phone:906-786-6047
Mailing Address - Fax:906-786-0660
Practice Address - Street 1:2525 5TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-786-6047
Practice Address - Fax:906-786-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B11004OtherBCBS GROUP
CG4010OtherRAILROAD MEDICARE GROUP
MI0M25870Medicare ID - Type UnspecifiedGROUP
MI0M25870Medicare PIN