Healthcare Provider Details

I. General information

NPI: 1598899478
Provider Name (Legal Business Name): CUSTOM HEARING CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25882 ORCHARD LAKE RD SUITE 103
FARMINGTON HILLS MI
48336-1292
US

IV. Provider business mailing address

25882 ORCHARD LAKE RD SUITE 103
FARMINGTON HILLS MI
48336-1292
US

V. Phone/Fax

Practice location:
  • Phone: 248-474-8161
  • Fax: 248-474-2966
Mailing address:
  • Phone: 248-474-8161
  • Fax: 248-474-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000305
License Number StateMI

VIII. Authorized Official

Name: STEPHEN WILLIAM GOFF
Title or Position: AUDIOLOGIST
Credential: MACCCA
Phone: 248-474-8161