=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225212020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NU-TONE HEARING CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2007
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5962 N LINCOLN AVE STE U2
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-271-1192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5962 N LINCOLN AVE STE U2
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-271-1192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SHAREHOLDER
-----------------------------------------------------
Name | DR. STAVROS BASSEAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-271-1192
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 1954
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------