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General NPI Number Information
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NPI Number | 1215442827
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Entity Type | Individual
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Provider Name | MICHAEL A DEROSA HIS
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Gender | Male
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 200 E CHICAGO AVE STE 102
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City | WESTMONT
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State | IL
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Zip | 60559-1756
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Country | US
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Telephone | 630-810-1340
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Fax | 630-598-0318
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Provider Business Mailing Address
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Address Line | 215 SHUMAN BLVD STE 401
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City | NAPERVILLE
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State | IL
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Zip | 60563-8123
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Country | US
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Telephone | 630-303-5380
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Fax | 630-303-5385
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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 | 3164
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License Number State | IL
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