MEDICARE: MRS. ANN MARIE CARBAJAL H.I.S.

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	599	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356300941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN MARIE CARBAJAL H.I.S.

Provider Business Mailing Address
First Line	:	5913 W HOWARD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1904
Country	:	US
Telephone Number	:	414-312-7111
Fax Number	:	414-321-7258

Provider Business Practice Location Address
First Line	:	5913 W HOWARD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1904
Country	:	US
Telephone Number	:	414-312-7111
Fax Number	:	414-321-7258

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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