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General NPI Number Information
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NPI Number | 1174762371
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Entity Type | Individual
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Provider Name | ELYSE SIMONE COMEAU
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Gender | Female
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 4072 CHICAGO DR SW STE 1
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City | GRANDVILLE
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State | MI
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Zip | 49418-1291
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Country | US
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Telephone | 616-530-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 E SHERMAN BLVD
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City | NORTON SHORES
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State | MI
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Zip | 49444-1809
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Country | US
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Telephone | 313-336-4140
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3501004797
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License Number State | MI
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