Healthcare Provider Details

I. General information

NPI: 1578603098
Provider Name (Legal Business Name): LIONS HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST SUITE 5E
DETROIT MI
48201-2153
US

IV. Provider business mailing address

3800 WOODWARD AVE SUITE 600
DETROIT MI
48201-2061
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-1740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT MATHOG
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 313-745-8100