Healthcare Provider Details

I. General information

NPI: 1538535992
Provider Name (Legal Business Name): LIFESTYLE HEARING PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MITCHELLVILLE RD SUITE B124
BOWIE MD
20716-3104
US

IV. Provider business mailing address

4000 MITCHELLVILLE RD SUITE B124
BOWIE MD
20716-3104
US

V. Phone/Fax

Practice location:
  • Phone: 301-464-2036
  • Fax: 301-464-9226
Mailing address:
  • Phone: 301-464-2036
  • Fax: 301-464-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVE DUTSON
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 786-563-4010