Healthcare Provider Details

I. General information

NPI: 1033462718
Provider Name (Legal Business Name): MICHELE FISCUS HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE CURRY

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 HAMPSHIRE RD STE B
WESTLAKE VILLAGE CA
91361-5936
US

IV. Provider business mailing address

597 N YORK ST
ELMHURST IL
60126-1903
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-3553
  • Fax:
Mailing address:
  • Phone: 630-833-8382
  • Fax: 630-833-8158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3063
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number8225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: