Healthcare Provider Details

I. General information

NPI: 1720552011
Provider Name (Legal Business Name): MICHAEL EMILIAN LAGRANGE HEARING SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2019
Last Update Date: 01/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 SUN CITY CENTER BLVD
SUN CITY CENTER FL
33573-6281
US

IV. Provider business mailing address

4850 SUN CITY CENTER BLVD
SUN CITY CENTER FL
33573-6281
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-8451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: