MEDICARE: MIRACLE EAR

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	:	1720287758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRACLE EAR

Provider Business Mailing Address
First Line	:	5000 CHESHIRE LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-3706
Country	:	US
Telephone Number	:	888-333-9152
Fax Number	:	763-268-4240

Provider Business Practice Location Address
First Line	:	2561 EL CAMINO REAL
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1202
Country	:	US
Telephone Number	:	760-729-6030
Fax Number	:	760-729-6071

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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Directions to “MIRACLE EAR ” Practice Location

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