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General NPI Number Information
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NPI Number | 1033467212
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Entity Type | Individual
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Provider Name | NICHOLAS JAMES LIIMATTA AU.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 3019 COIT AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3376
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Country | US
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Telephone | 269-966-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 3880 YORKLAND DR NW APT 8
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City | COMSTOCK PARK
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State | MI
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Zip | 49321-8429
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Country | US
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Telephone | 262-993-2816
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AT006263
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License Number State | PA
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