Sault Otolaryngology & Facial Plastic Surgery PC

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

5101015234 Issued in MI

Legal business name

SAULT OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY PC

Practice address

333 Magazine St
Ste 101
Sault Sainte Marie, MI 49783-1867

Phone

(906) 259-0244

Fax

(906) 259-0247

NPI assigned

Oct 16, 2012

Last updated

Oct 16, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark A Wallace, DO

Title

President

Phone

(808) 937-7037

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350345600000",
    "number": "1699028613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 MAGAZINE ST",
            "address_2": "STE 101",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831867",
            "telephone_number": "906-259-0244",
            "fax_number": "906-259-0247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 MAGAZINE ST",
            "address_2": "STE 101",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831867",
            "telephone_number": "906-259-0244",
            "fax_number": "906-259-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAULT OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-16",
        "last_updated": "2012-10-16",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-937-7037",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MI",
            "license": "5101015234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna R Sanderson
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• Muhammad Sardar, MD
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• Sault Tribe of Chippewa Indians
• Sault Tribe of Chippewa Indians
• Sault Tribe of Chippewa Indians (Healing Place)

• Otolaryngology/Facial Plastic Surgery Physician in Sault Sainte Marie, MI
• Providers in Sault Sainte Marie, MI by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.