Basic Information
Provider Information | |||||||||
NPI: | 1609890375 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | DEARBORN HEARING AIDS INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 15212 MICHIGAN AVE | ||||||||
Address2: | DEARBORN HEARING AIDS INC | ||||||||
City: | DEARBORN | ||||||||
State: | MI | ||||||||
PostalCode: | 481263497 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3135828852 | ||||||||
FaxNumber: | 3135826417 | ||||||||
Practice Location | |||||||||
Address1: | 15212 MICHIGAN AVE | ||||||||
Address2: | DEARBORN HEARING AIDS INC | ||||||||
City: | DEARBORN | ||||||||
State: | MI | ||||||||
PostalCode: | 481263497 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3135828852 | ||||||||
FaxNumber: | 3135826417 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/27/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MACDONALD | ||||||||
AuthorizedOfficialFirstName: | MICHAEL | ||||||||
AuthorizedOfficialMiddleName: | ALLEN | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF AUDIOLOGY | ||||||||
AuthorizedOfficialTelephone: | 3135828852 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | AU. D CCC-A | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 3501003225 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.