Healthcare Provider Details

I. General information

NPI: 1851797088
Provider Name (Legal Business Name): HAYDEN ELLERY GURMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 N POST RD
INDIANAPOLIS IN
46219-4213
US

IV. Provider business mailing address

1523 N POST RD
INDIANAPOLIS IN
46219
US

V. Phone/Fax

Practice location:
  • Phone: 317-899-4511
  • Fax:
Mailing address:
  • Phone: 317-899-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001404
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: