Healthcare Provider Details

I. General information

NPI: 1669918306
Provider Name (Legal Business Name): ANDREW HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 TUTOR LN
EVANSVILLE IN
47715-9115
US

IV. Provider business mailing address

1401 MITCHELL CT
EVANSVILLE IN
47715-6227
US

V. Phone/Fax

Practice location:
  • Phone: 812-473-8000
  • Fax: 812-473-6000
Mailing address:
  • Phone: 812-870-4747
  • Fax: 812-473-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001352A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: