1760625651 NPI number — MICHIGAN AUDIOLOGY & HEARING CENTER, PLLC

Table of content: (NPI 1760625651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760625651 NPI number — MICHIGAN AUDIOLOGY & HEARING CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN AUDIOLOGY & HEARING CENTER, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1760625651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35054 23 MILE RD
Provider Second Line Business Mailing Address:
BLDG. B., SUITE 104
Provider Business Mailing Address City Name:
NEW BALTIMORE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48047-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-716-0500
Provider Business Mailing Address Fax Number:
586-716-0789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35054 23 MILE RD
Provider Second Line Business Practice Location Address:
BLDG. B., SUITE 104
Provider Business Practice Location Address City Name:
NEW BALTIMORE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48047-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-716-0500
Provider Business Practice Location Address Fax Number:
586-716-0789
Provider Enumeration Date:
04/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GERBINO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
AUDIOLOGIST/OWNER
Authorized Official Telephone Number:
586-716-0500

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  1601000037 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 540E003140 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN-HEARING AID DEALER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 640E026870 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN-AUDIOLOGIST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".