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General NPI Number Information
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NPI Number | 1801610969
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Entity Type | Individual
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Provider Name | IAN ANDERSON HIS
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Gender | Male
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 2216 MOUNTAIN SHADOW DR
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City | DULUTH
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State | MN
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Zip | 55811-3838
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Country | US
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Telephone | 218-722-6611
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Fax | 218-249-0736
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Provider Business Mailing Address
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Address Line | 2216 MOUNTAIN SHADOW DR
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City | DULUTH
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State | MN
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Zip | 55811-3838
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Country | US
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Telephone | 218-722-6611
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Fax | 218-249-0736
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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 | 2075-60
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2965
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 134325
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License Number State | IA
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