Ear Nose & Throat Institute Facial Surgery Group PA

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

ME42748 Issued in FL

Legal business name

EAR NOSE & THROAT INSTITUTE FACIAL SURGERY GROUP PA

Practice address

13691 Metro Pkwy
Ste 420
Fort Myers, FL 33912-4327

Phone

(239) 768-7332

Fax

(239) 768-2197

NPI assigned

Apr 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Harold Kushner, M.D.

Title

President

Phone

(239) 768-7332

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340841600000",
    "number": "1124141312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7518",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339117518",
            "telephone_number": "239-931-7262",
            "fax_number": "239-931-7397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13691 METRO PKWY",
            "address_2": "STE 420",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124327",
            "telephone_number": "239-768-7332",
            "fax_number": "239-768-2197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE & THROAT INSTITUTE FACIAL SURGERY GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2012-06-28",
        "status": "A",
        "authorized_official_last_name": "KUSHNER",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-768-7332",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME42748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040308300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER",
            "identifier": "DS2037",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Otolaryngology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.