MEDICARE: JEFF LENN KOGLIN

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	3501001531	MI

General Provider Information

NPI Number	:	1578634317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF LENN KOGLIN

Provider Business Mailing Address
First Line	:	1252 SAND BEACH RD
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-8817
Country	:	US
Telephone Number	:	989-269-4327
Fax Number	:	989-269-2251

Provider Business Practice Location Address
First Line	:	1252 SAND BEACH RD
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-8817
Country	:	US
Telephone Number	:	989-269-4327
Fax Number	:	989-269-2251

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/09/2007

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