MEDICARE: KARSON GLASS

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

General Provider Information

NPI Number	:	1558848374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARSON GLASS

Provider Business Mailing Address
First Line	:	3100 N WELLNESS DR
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8122
Country	:	US
Telephone Number	:	616-994-2770
Fax Number	:

Provider Business Practice Location Address
First Line	:	6140 28TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6938
Country	:	US
Telephone Number	:	616-988-4327
Fax Number	:

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	02/18/2020

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Directions to “ KARSON GLASS ” Practice Location

Language	Start Address	Practice Location

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