Healthcare Provider Details

I. General information

NPI: 1669943221
Provider Name (Legal Business Name): IAN MAREK MISHLER BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 COMMERCIAL ST STE 102
BATH ME
04530-2505
US

IV. Provider business mailing address

51 BOG RD
DRESDEN ME
04342-3214
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-3163
  • Fax:
Mailing address:
  • Phone: 207-481-3451
  • Fax: 207-481-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberDL443
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: