1083924799 NPI number — KATHLEEN M WIRTZ HEARING AID DEALER

Table of content: KATHLEEN M WIRTZ HEARING AID DEALER (NPI 1083924799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083924799 NPI number — KATHLEEN M WIRTZ HEARING AID DEALER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIRTZ
Provider First Name:
KATHLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HEARING AID DEALER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083924799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 W HIGGINS RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60169-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-843-1900
Provider Business Mailing Address Fax Number:
847-843-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
557 EMMETT ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49017-5682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-965-3305
Provider Business Practice Location Address Fax Number:
269-965-8809
Provider Enumeration Date:
10/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)