Healthcare Provider Details

I. General information

NPI: 1811851165
Provider Name (Legal Business Name): MIDWEST AUDIOLOGY & HEARING CENTER FITCHBURG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PEMBROKE DRIVE
MADISON WI
53711
US

IV. Provider business mailing address

2727 PEMBROKE DRIVE
MADISON WI
53711
US

V. Phone/Fax

Practice location:
  • Phone: 608-273-3036
  • Fax:
Mailing address:
  • Phone: 608-273-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DOUG KLOSS
Title or Position: OWNER, CAO
Credential: AUD
Phone: 414-281-8300