Basic Information
| Provider Information | |||||||||
| NPI: | 1487095527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNSAL | ||||||||
| FirstName: | AYKUT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 N BROAD ST FL 10 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157625530 | ||||||||
| FaxNumber: | 2157625540 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 N BROAD ST FL 10 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157625530 | ||||||||
| FaxNumber: | 2157625540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 080410 | GA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207YX0905X | OS019971 | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 080410 | 01 | GA | MEDICAL LICENSE | OTHER |