Healthcare Provider Details

I. General information

NPI: 1821249558
Provider Name (Legal Business Name): BENJAMIN NORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 3 MILE RD NW
GRAND RAPIDS MI
49544-1650
US

IV. Provider business mailing address

1802 GALLOWAY STREET
EAU CLAIRE WI
54703
US

V. Phone/Fax

Practice location:
  • Phone: 616-538-5300
  • Fax: 616-538-5006
Mailing address:
  • Phone: 715-831-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501004919
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: