MEDICARE: MIRACLE-EAR, INC.

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	:	1447485560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE-EAR, INC.

Provider Business Mailing Address
First Line	:	5000 CHESHIRE PKWY N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-4103
Country	:	US
Telephone Number	:	763-268-4084
Fax Number	:	763-268-4430

Provider Business Practice Location Address
First Line	:	8046 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2407
Country	:	US
Telephone Number	:	763-315-6571
Fax Number	:	763-315-6687

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	PAUL D'AMICO
Credential	:
Telephone Number	:	888-333-9152

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	10/26/2010

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Directions to “MIRACLE-EAR, INC. ” Practice Location

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