Healthcare Provider Details

I. General information

NPI: 1902173925
Provider Name (Legal Business Name): DOUGLAS MENGEL HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 23RD AVE STE E1
BOZEMAN MT
59718-3965
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 406-585-4669
  • Fax: 406-585-4671
Mailing address:
  • Phone: 612-351-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number397
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: