Healthcare Provider Details

I. General information

NPI: 1417381922
Provider Name (Legal Business Name): BAY HEARING CONSERVATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SHAWANO AVE SUITE 110W
GREEN BAY WI
54303-3246
US

IV. Provider business mailing address

1600 SHAWANO AVE SUITE 110W
GREEN BAY WI
54303-3246
US

V. Phone/Fax

Practice location:
  • Phone: 920-499-6366
  • Fax: 920-499-2981
Mailing address:
  • Phone: 920-499-6366
  • Fax: 920-499-2981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number26-156
License Number StateWI

VIII. Authorized Official

Name: MR. PAUL F. KURLAND
Title or Position: AUDIOLOGIST
Credential: M.A.
Phone: 920-499-6366