MEDICARE: MIDWEST HEARING SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093191116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST HEARING SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	4579 32 MILE RD
Second Line	:
City	:	BRUCE TWP
State	:	MI
Zip	:	48065-4101
Country	:	US
Telephone Number	:	586-242-2279
Fax Number	:

Provider Business Practice Location Address
First Line	:	4579 32 MILE RD
Second Line	:
City	:	BRUCE TWP
State	:	MI
Zip	:	48065-4101
Country	:	US
Telephone Number	:	586-242-2279
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA KONTOS--LOGRASSO
Credential	:
Telephone Number	:	586-242-2279

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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