MEDICARE: MIRACLE EAR

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	237600000X	Audiologist-Hearing Aid Fitter

General Provider Information

NPI Number	:	1316118243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE EAR

Provider Business Mailing Address
First Line	:	12737 RIVERDALE BLVD NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-1253
Country	:	US
Telephone Number	:	763-421-1688
Fax Number	:

Provider Business Practice Location Address
First Line	:	12737 RIVERDALE BLVD NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-1253
Country	:	US
Telephone Number	:	763-421-1688
Fax Number	:	763-421-1788

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TIMOTHY V VOTAVA
Credential	:
Telephone Number	:	763-421-1688

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	07/09/2009

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Directions to “MIRACLE EAR ” Practice Location

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