MEDICARE: MARY KEMPE HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	IL.03412	OH

General Provider Information

NPI Number	:	1174170500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KEMPE HIS

Provider Business Mailing Address
First Line	:	2221 EQUESTRIAN DR APT 1A
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-5661
Country	:	US
Telephone Number	:	330-464-7790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1370 N FAIRFIELD RD STE F
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2681
Country	:	US
Telephone Number	:	937-320-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	08/21/2019

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