MEDICARE: MR. CHRISTOPHER GEORGE MACRIDES LHAS

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	02108	OH

General Provider Information

NPI Number	:	1578688222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER GEORGE MACRIDES LHAS

Provider Business Mailing Address
First Line	:	1201 30TH ST NW STE. #104B
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-2959
Country	:	US
Telephone Number	:	330-492-1212
Fax Number	:	330-492-9655

Provider Business Practice Location Address
First Line	:	1201 30TH ST NW STE. #104B
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-2959
Country	:	US
Telephone Number	:	330-492-1212
Fax Number	:	330-492-9655

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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