Healthcare Provider Details

I. General information

NPI: 1972993160
Provider Name (Legal Business Name): CHAD HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3077 E 98TH ST STE 270
INDIANAPOLIS IN
46280-2909
US

IV. Provider business mailing address

10437 ILLINOIS RD
FORT WAYNE IN
46814-9181
US

V. Phone/Fax

Practice location:
  • Phone: 317-843-9001
  • Fax:
Mailing address:
  • Phone: 260-426-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001214A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: