Healthcare Provider Details

I. General information

NPI: 1275799538
Provider Name (Legal Business Name): SUSAN GRAFMAN HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N COMMONS DR STE 200
AURORA IL
60504-7940
US

IV. Provider business mailing address

331 N SPARKS ST
BURBANK CA
91506-1960
US

V. Phone/Fax

Practice location:
  • Phone: 800-675-5485
  • Fax:
Mailing address:
  • Phone: 818-842-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: