MEDICARE: NOA AVIGAL DIMBERT AUD

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	1061-156	WI

General Provider Information

NPI Number	:	1518708049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOA AVIGAL DIMBERT AUD

Provider Business Mailing Address
First Line	:	1950 W GOOD HOPE RD APT 3
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-2845
Country	:	US
Telephone Number	:	965-686-4416
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 W WISCONSIN AVE STE B340
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4874
Country	:	US
Telephone Number	:	414-266-2934
Fax Number	:	414-266-6189

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/14/2024

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