Basic Information
| Provider Information | |||||||||
| NPI: | 1598187353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARING CENTER OF EXCELLENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22731 NEWMAN ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135828852 | ||||||||
| FaxNumber: | 3135826417 | ||||||||
| Practice Location | |||||||||
| Address1: | 22731 NEWMAN ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135828852 | ||||||||
| FaxNumber: | 3135826417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2014 | ||||||||
| LastUpdateDate: | 01/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | MACDONALD | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3135828852 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | AU.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 1601000653 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.