Healthcare Provider Details

I. General information

NPI: 1043549140
Provider Name (Legal Business Name): INNOVATIVE EAR & HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43184 DEQUINDRE RD SUITE 204
STERLING HEIGHTS MI
48314-1709
US

IV. Provider business mailing address

43184 DEQUINDRE RD SUITE 204
STERLING HEIGHTS MI
48314-1709
US

V. Phone/Fax

Practice location:
  • Phone: 586-991-0450
  • Fax:
Mailing address:
  • Phone: 586-991-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501002668
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number3501002668
License Number StateMI

VIII. Authorized Official

Name: KEVIN S. HARTIG
Title or Position: OWNER
Credential: BC/HIS
Phone: 586-991-0450