Healthcare Provider Details

I. General information

NPI: 1992840540
Provider Name (Legal Business Name): HEARCARE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 LAKE AVE SUITE #23
FORT WAYNE IN
46805-5428
US

IV. Provider business mailing address

3030 LAKE AVE SUITE #23
FORT WAYNE IN
46805-5428
US

V. Phone/Fax

Practice location:
  • Phone: 260-485-1231
  • Fax: 260-486-6958
Mailing address:
  • Phone: 260-485-1231
  • Fax: 260-486-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number58000024A
License Number StateIN

VIII. Authorized Official

Name: MR. KENNETH R. STEWART
Title or Position: PRESIDENT
Credential: M.A. F-AAA
Phone: 260-485-1231