Healthcare Provider Details

I. General information

NPI: 1609915735
Provider Name (Legal Business Name): MR. ANDREW CMEYLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 GOLDEN DR
HUBERTUS WI
53033-9790
US

IV. Provider business mailing address

1546 GOLDEN DR
HUBERTUS WI
53033-9790
US

V. Phone/Fax

Practice location:
  • Phone: 414-355-1700
  • Fax: 262-628-4673
Mailing address:
  • Phone: 414-355-1700
  • Fax: 262-628-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1263-060
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: