Grand Rapids Ear Nose & Throat Center PLLC
Organization Active NPI Otolaryngology Physician · Grand Rapids, MI
NPI 1124052337 · NPPES record last updated Jul 21, 2008
Key facts
- NPI
- 1124052337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- Legal business name
- GRAND RAPIDS EAR NOSE & THROAT CENTER PLLC
- Practice address
- 655 Kenmoor Ave SE
Suite a
Grand Rapids, MI 49546-8622 - Phone
- (616) 575-1212
- Fax
- (616) 575-1219
- NPI assigned
- Jul 11, 2006
- Organization subpart
- No
Authorized official
- Name
- John Michael Kosta, M.D.
- Title
- President
- Phone
- (616) 575-1212
Practitioners 15
-
Jessica Jones Bruinius, M.S.
-
Robert L Daniels, M.D.
-
Darryl J Elzinga, M.D.
-
Megan Justine Gustavson, AU.D
-
Mark Robert Winkle, M.D.
-
Erin Ashley Attruia, PA-C
-
Ashley Megan La Fave, PA-C
-
Nora Anne Lignell, M.A,, CCC-A
-
Tamara L Thelen, AU.D., CCC-A
-
Grace Greene, AUD
-
John Michael Kosta, M.D.
-
Carol Byrne, AU.D.
-
Amy Rogghe, PA-C
-
Chad Afman, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080703000320 | MI | Part B Supplier - Clinic/Group Practice | 0547332751 |
Receives reassigned benefits from 14 practitioners Practice locations: Grand Rapids, MI |
National Provider Directory
Locations
2373 64th St SW
Byron Center, MI 49315
Phone (616) 685-1350
2373 64th St SW
Ste 2300
Byron Center, MI 49315
655 Kenmoor Ave SE
Grand Rapids, MI 49546
Phone (616) 575-1212
655 Kenmoor Ave SE
Ste A
Grand Rapids, MI 49546
Phone (616) 575-1208
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician |
207Y00000X | Yes |
Addresses
Primary practice location
655 Kenmoor Ave SE
Suite a
Grand Rapids, MI 49546-8622
Mailing address
655 Kenmoor Ave SE
Suite a
Grand Rapids, MI 49546-8622
Phone (616) 575-1212
Other names
- Ear, Nose and Throat Center, P.C.
Other providers in Grand Rapids, MI
- Grand Rapids Center for Psychotherapy PLLC
- Grand Rapids Chiropractic and Acupuncture
- Grand Rapids Counseling Services
- Grand Rapids Counseling, LLC
- Grand Rapids Dentistry PLC
- Grand Rapids Ellington Academy of Arts & Technology
- Grand Rapids Eye Care 2820 PLLC
- Grand Rapids Eye Institute, PLC
- Grand Rapids Family Chiropractic Inc
- Grand Rapids Family Dentistry
All providers in Grand Rapids, MI · Otolaryngology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.