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General NPI Number Information
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NPI Number | 1003137365
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Entity Type | Organization
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Legal Business Name | PETOSKEY HEARING AID CENTER
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 1614 S US 131 S
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City | PETOSKEY
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State | MI
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Zip | 49770
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Country | US
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Telephone | 231-347-2431
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Fax | 231-347-2431
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Provider Business Mailing Address
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Address Line | 1614 S US 131
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City | PETOSKEY
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State | MI
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Zip | 49770
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Country | US
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Telephone | 231-347-2431
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Fax | 231-347-2431
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL GOLAS
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Credential |
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Telephone | 231-347-2431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3501001479
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License Number State | MI
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