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General NPI Number Information
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NPI Number | 1427717263
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Entity Type | Individual
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Provider Name | MILES MAXWELL HIS
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Gender | Male
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 3140 N GLASSFORD HILL RD STE 103
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1210
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Country | US
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Telephone | 916-230-6018
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Fax |
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Provider Business Mailing Address
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Address Line | 3140 N GLASSFORD HILL RD STE 103
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1210
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Country | US
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Telephone |
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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 | HADE11714
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License Number State | AZ
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