MEDICARE: MARISA PEPPER HIS

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	3502013281	MI

General Provider Information

NPI Number	:	1528802204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA PEPPER HIS

Provider Business Mailing Address
First Line	:	4095 CHICAGO DR SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1296
Country	:	US
Telephone Number	:	616-261-0417
Fax Number	:	616-261-1459

Provider Business Practice Location Address
First Line	:	4095 CHICAGO DR SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1296
Country	:	US
Telephone Number	:	616-261-0417
Fax Number	:	616-261-1459

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

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	06/19/2024

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Directions to “ MARISA PEPPER HIS” Practice Location

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