Healthcare Provider Details

I. General information

NPI: 1437384609
Provider Name (Legal Business Name): MIRACLE-EAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13003 RIDGEDALE DR
MINNETONKA MN
55305-1807
US

IV. Provider business mailing address

5000 CHESHIRE PKWY N
PLYMOUTH MN
55446-4103
US

V. Phone/Fax

Practice location:
  • Phone: 952-545-2106
  • Fax: 952-541-9937
Mailing address:
  • Phone: 763-268-4115
  • Fax: 877-853-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MS. VERA PETERSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 888-510-0766