MEDICARE: MIDWEST AUDIOLOGY & HEARING CENTER, LLC

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	231H00000X	Audiologist	152156	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83991	OTHER	WI	MEDICARE PTAN

General Provider Information

NPI Number	:	1215350251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST AUDIOLOGY & HEARING CENTER, LLC

Provider Business Mailing Address
First Line	:	4818 S 76TH ST STE 12
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4362
Country	:	US
Telephone Number	:	414-281-8300
Fax Number	:	414-455-0159

Provider Business Practice Location Address
First Line	:	4818 S 76TH ST
Second Line	:	SUITE 3
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4362
Country	:	US
Telephone Number	:	414-281-8300
Fax Number	:	414-455-0159

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DOUGLAS A KLOSS
Credential	:	AUD
Telephone Number	:	414-281-8300

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	12/06/2025

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