Healthcare Provider Details

I. General information

NPI: 1346482122
Provider Name (Legal Business Name): MICHAEL LEE CAUDILL BC-HIS;HAS;ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 3RD ST S
JACKSONVILLE BEACH FL
32250-6310
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 904-246-1660
  • Fax: 503-659-5968
Mailing address:
  • Phone: 612-351-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS3317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: