Basic Information
| Provider Information | |||||||||
| NPI: | 1104808898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W FAYETTE STREET | ||||||||
| Address2: | STE 400 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154721488 | ||||||||
| FaxNumber: | 3154761792 | ||||||||
| Practice Location | |||||||||
| Address1: | 5639 W GENESEE STREET | ||||||||
| Address2: | |||||||||
| City: | CAMILLUS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154686888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 05/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0602X | 154623 | NY | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | 207Y00000X | 154623 | NY | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YS0012X | 154623 | NY | N | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine |
No ID Information.