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General NPI Number Information
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NPI Number | 1528064474
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Entity Type | Individual
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Provider Name | MITCHELL D. MARCUS BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 8714 LYNDALE AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55420-2738
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Country | US
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Telephone | 952-881-1188
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Fax | 952-881-1180
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Provider Business Mailing Address
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Address Line | 2800 W HIGGINS RD SUITE 895
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-2071
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Country | US
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Telephone | 847-843-1900
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Fax | 847-843-1901
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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 | 2090
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License Number State | MN
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