Basic Information
| Provider Information | |||||||||
| NPI: | 1831328574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHGATE EAR NOSE AND THROAT PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NOEL RENDLEMAN | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14500 NORTHLINE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342814197 | ||||||||
| FaxNumber: | 7342820093 | ||||||||
| Practice Location | |||||||||
| Address1: | 14500 NORTHLINE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342814197 | ||||||||
| FaxNumber: | 7342820093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2009 | ||||||||
| LastUpdateDate: | 07/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | GARLAPATY | ||||||||
| AuthorizedOfficialFirstName: | VASUDEV | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7342814197 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.