MEDICARE: PAUL FAUCHER

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 4994	FL

General Provider Information

NPI Number	:	1215300330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL FAUCHER

Provider Business Mailing Address
First Line	:	215 SHUMAN BLVD
Second Line	:	STE 401
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8458
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	978-313-6824

Provider Business Practice Location Address
First Line	:	235 CITRUS TOWER BLVD
Second Line	:	STE 106
City	:	CLERMONT
State	:	FL
Zip	:	34711-2711
Country	:	US
Telephone Number	:	352-243-1212
Fax Number	:	352-243-6474

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

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	11/20/2015

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