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General NPI Number Information
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NPI Number | 1700053568
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Entity Type | Organization
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Legal Business Name | HAGEMAN AUDIOLOGY & HEARING AIDS LLC
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 2505 EAST PARIS AVE SE SUITE 170
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2422
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Country | US
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Telephone | 616-285-3733
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Fax | 616-288-3745
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Provider Business Mailing Address
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Address Line | 2505 EAST PARIS AVE SE SUITE 170
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2422
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Country | US
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Telephone | 616-285-3733
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Fax | 616-288-3745
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD G HAGEMAN
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Credential | AUD
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Telephone | 616-285-3733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 1601000046
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License Number State | MI
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