MEDICARE: MARY BETH MIHALICK AU. D.

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	A.00337	OH

General Provider Information

NPI Number	:	1952572463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH MIHALICK AU. D.

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD BLDG B3
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3188
Fax Number	:	937-223-9811

Provider Business Practice Location Address
First Line	:	31 S STANFIELD RD STE 304
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-2334
Country	:	US
Telephone Number	:	937-440-7872
Fax Number	:	937-440-7874

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

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	07/21/2022

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