Healthcare Provider Details

I. General information

NPI: 1093191116
Provider Name (Legal Business Name): MIDWEST HEARING SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
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 Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA KONTOS--LOGRASSO
Title or Position: OWNER
Credential:
Phone: 586-242-2279