=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659543106
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY ALLEN KINCER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2008
-----------------------------------------------------
Last Update Date | 03/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41570 HAYES RD STE E2
-----------------------------------------------------
City | CLINTON TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48038-5867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-263-3660
-----------------------------------------------------
Fax | 586-263-4160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41570 HAYES RD STE E2
-----------------------------------------------------
City | CLINTON TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48038-5867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-263-3660
-----------------------------------------------------
Fax | 586-263-4160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 3501003038
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------