Healthcare Provider Details

I. General information

NPI: 1952602997
Provider Name (Legal Business Name): JOSHUA G ELZINGA AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 CALUMET AVE STE 201
VALPARAISO IN
46383-2286
US

IV. Provider business mailing address

3907 CALUMET AVE STE 201
VALPARAISO IN
46383-2286
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-6866
  • Fax: 219-462-9369
Mailing address:
  • Phone: 219-462-6866
  • Fax: 219-462-9369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002488A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number23002488A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: