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General NPI Number Information
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NPI Number | 1720139967
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Entity Type | Organization
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Legal Business Name | GREGORY J MAAG, MA-CCCA MID AMERICA AUDIOLOGY GROUP, LTD
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 1417 WASHINGTON AVE STE 2
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City | ALTON
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State | IL
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Zip | 62002-3964
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Country | US
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Telephone | 618-462-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 WASHINGTON AVE STE 2
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City | ALTON
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State | IL
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Zip | 62002-3964
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Country | US
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Telephone | 618-462-7900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GREGORY J MAAG
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Credential | MA-CCCA
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Telephone | 618-462-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State | IL
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