Healthcare Provider Details

I. General information

NPI: 1700053568
Provider Name (Legal Business Name): HAGEMAN AUDIOLOGY & HEARING AIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 EAST PARIS AVE SE SUITE 170
GRAND RAPIDS MI
49546-2422
US

IV. Provider business mailing address

2505 EAST PARIS AVE SE SUITE 170
GRAND RAPIDS MI
49546-2422
US

V. Phone/Fax

Practice location:
  • Phone: 616-285-3733
  • Fax: 616-288-3745
Mailing address:
  • Phone: 616-285-3733
  • Fax: 616-288-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1601000046
License Number StateMI

VIII. Authorized Official

Name: MR. RONALD G HAGEMAN
Title or Position: PRESIDENT
Credential: AUD
Phone: 616-285-3733