Healthcare Provider Details

I. General information

NPI: 1861325433
Provider Name (Legal Business Name): MICHAEL DIRMISH AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10855 VIRGINIA ST
CROWN POINT IN
46307-0210
US

IV. Provider business mailing address

236 N ADDISON AVE
ELMHURST IL
60126-2723
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1865
  • Fax:
Mailing address:
  • Phone: 630-303-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.012350
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002959A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: