Healthcare Provider Details

I. General information

NPI: 1972147650
Provider Name (Legal Business Name): MICHAEL T WARREN H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 W SAGINAW HWY
LANSING MI
48917-2656
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 517-657-7184
  • Fax: 517-708-7454
Mailing address:
  • Phone: 616-538-5300
  • Fax: 616-538-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501004749
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: