=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245439207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIRACLE EAR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 07/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6514 ODANA RD SUITE 7
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53719-1124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-829-3777
-----------------------------------------------------
Fax | 608-829-0430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000 CHESHIRE LN N
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55446-3706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-333-9152
-----------------------------------------------------
Fax | 763-268-4240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | PAUL M D'AMICO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-333-9152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------