MEDICARE: DR. JEFFERY DAVID REGAL AU.D.,CCC-A

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	231H00000X	Audiologist	23002023A	IN

General Provider Information

NPI Number	:	1235203878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY DAVID REGAL AU.D.,CCC-A

Provider Business Mailing Address
First Line	:	2440 JEFFREY LN
Second Line	:
City	:	NILES
State	:	MI
Zip	:	49120-7706
Country	:	US
Telephone Number	:	269-684-2324
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NAVARRE PLACE
Second Line	:	SUITE 4430
City	:	SOUTH BEND
State	:	IN
Zip	:	46601-1171
Country	:	US
Telephone Number	:	574-246-1000
Fax Number	:	574-246-4000

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	12/20/2007

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