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General NPI Number Information
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NPI Number | 1639488927
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Entity Type | Organization
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Legal Business Name | LIFESTYLE HEARING CENTER LLC
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 3410 FEDERAL DR SUITE101
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City | EAGAN
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State | MN
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Zip | 55122-1320
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Country | US
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Telephone | 651-788-9008
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Fax | 651-340-5728
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Provider Business Mailing Address
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Address Line | 3410 FEDERAL DR SUITE101
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City | EAGAN
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State | MN
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Zip | 55122-1320
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Country | US
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Telephone | 651-788-9008
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Fax | 651-340-5728
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID RAEL
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Credential | H.I.D
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Telephone | 651-788-9008
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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 | 2653
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License Number State | MN
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