=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306215199
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATJK HEARING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2015
-----------------------------------------------------
Last Update Date | 09/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15060 W GREENFIELD AVE STE 100
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53005-7061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-789-5337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6517 CANARY LN
-----------------------------------------------------
City | ALLENTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53002-9754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-629-1703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | MRS. MICHELLE KRIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-483-6095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------