MEDICARE: DEAN KNOBLACH HAS

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	237700000X	Hearing Instrument Specialist	AS 4890	FL

General Provider Information

NPI Number	:	1164849170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN KNOBLACH HAS

Provider Business Mailing Address
First Line	:	4196 EAGLE WATCH BLVD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3317
Country	:	US
Telephone Number	:	727-480-1829
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 E BAY DR
Second Line	:	SUITE 17
City	:	LARGO
State	:	FL
Zip	:	33771-2467
Country	:	US
Telephone Number	:	727-530-3533
Fax Number	:	727-535-5793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/27/2014

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