Healthcare Provider Details

I. General information

NPI: 1336432483
Provider Name (Legal Business Name): GRAND HEARING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E GRAND RIVER AVE SUITE B
PORTLAND MI
48875-1630
US

IV. Provider business mailing address

1330 E GRAND RIVER AVE SUITE B
PORTLAND MI
48875-1630
US

V. Phone/Fax

Practice location:
  • Phone: 517-526-0390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000414
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1601000414
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1601000414
License Number StateMI

VIII. Authorized Official

Name: MR. DOUGLAS A LOGEL JR.
Title or Position: OWNER - AUDIOLOGIST
Credential:
Phone: 517-526-0390