MEDICARE: ERICA L DMUCHOSKI WRIGHT AU.D.

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	1601000446	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1601000446	OTHER	MI	AUDIOLOGIST LICENSE

General Provider Information

NPI Number	:	1346360799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA L DMUCHOSKI WRIGHT AU.D.

Provider Business Mailing Address
First Line	:	PO BOX 406153
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-6153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 CANAL AVE SW
Second Line	:	SUITE #203
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2667
Country	:	US
Telephone Number	:	616-257-7880
Fax Number	:	616-257-0580

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	02/04/2009

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