MEDICARE: KENNETH PROSS

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	02793	OH

General Provider Information

NPI Number	:	1740575414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH PROSS

Provider Business Mailing Address
First Line	:	9040 SANDY OAKS TRL
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-9645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6555 WILSON MILLS RD
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3435
Country	:	US
Telephone Number	:	440-684-0213
Fax Number	:

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

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/10/2011

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Directions to “ KENNETH PROSS ” Practice Location

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