Healthcare Provider Details

I. General information

NPI: 1699948505
Provider Name (Legal Business Name): CYNTHIA ANNE KONTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4579 32 MILE RD
BRUCE TWP MI
48065-4101
US

IV. Provider business mailing address

4579 32 MILE RD
BRUCE TWP MI
48065-4101
US

V. Phone/Fax

Practice location:
  • Phone: 586-242-2279
  • Fax:
Mailing address:
  • Phone: 586-242-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501003428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: